1154428654 NPI number — CVS PHARMACY INC

Table of content: (NPI 1154428654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154428654 NPI number — CVS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CVS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154428654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CVS DR
Provider Second Line Business Mailing Address:
PO BOX 1075
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-6146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3012 MOCKINGBIRD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75205-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-363-5525
Provider Business Practice Location Address Fax Number:
214-363-8734
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAURICIO
Authorized Official First Name:
CRISTIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR PHCY ENROLLMENTS
Authorized Official Telephone Number:
401-770-2937

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  24952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000460406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4507147 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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