MEDICARE: CVS CAREMARK

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	36537	SC

General Provider Information

NPI Number	:	1750835195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS CAREMARK

Provider Business Mailing Address
First Line	:	4401 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5254
Country	:	US
Telephone Number	:	843-272-8884
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	CRYSTAL DONJON
Credential	:
Telephone Number	:	843-626-3951

Provider Enumeration Date	:	08/13/2016
Last Update Date	:	08/13/2016

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Directions to “CVS CAREMARK ” Practice Location

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