Provider Demographics
NPI:1194075531
Name:CVS PHARMACY
Entity type:Organization
Organization Name:CVS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BUTZ
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:864-871-4323
Mailing Address - Street 1:3312 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:29205
Mailing Address - State:SC
Mailing Address - Zip Code:29205
Mailing Address - Country:US
Mailing Address - Phone:803-748-8588
Mailing Address - Fax:
Practice Address - Street 1:3312 DEVINE ST
Practice Address - Street 2:
Practice Address - City:29205
Practice Address - State:SC
Practice Address - Zip Code:29205
Practice Address - Country:US
Practice Address - Phone:803-748-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy