Provider Demographics
NPI:1699124057
Name:CVS/PHARMACY
Entity type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONTANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULHUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:603-455-4312
Mailing Address - Street 1:1279 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3101
Mailing Address - Country:US
Mailing Address - Phone:203-755-5490
Mailing Address - Fax:
Practice Address - Street 1:1279 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3101
Practice Address - Country:US
Practice Address - Phone:203-755-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00129193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy