MEDICARE: CVS/PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	0012919	CT

General Provider Information

NPI Number	:	1699124057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS/PHARMACY

Provider Business Mailing Address
First Line	:	1279 W MAIN ST
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3101
Country	:	US
Telephone Number	:	203-755-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1279 W MAIN ST
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3101
Country	:	US
Telephone Number	:	203-755-5490
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANGER
Name	:	MS. MONTANNA J. PAULHUS
Credential	:	PHARMD
Telephone Number	:	603-455-4312

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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Directions to “CVS/PHARMACY ” Practice Location

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