Provider Demographics
NPI:1487061198
Name:CVS/PHARMACY
Entity type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANDORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-981-6253
Mailing Address - Street 1:6310 TERRA VERDE DR
Mailing Address - Street 2:APT 347
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5392
Mailing Address - Country:US
Mailing Address - Phone:919-760-0402
Mailing Address - Fax:
Practice Address - Street 1:3500 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7307
Practice Address - Country:US
Practice Address - Phone:919-855-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty