Provider Demographics
NPI:1023485539
Name:CVS
Entity type:Organization
Organization Name:CVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-716-5153
Mailing Address - Street 1:8839 STONEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1415
Mailing Address - Country:US
Mailing Address - Phone:919-449-6230
Mailing Address - Fax:
Practice Address - Street 1:6480 OLD WATERLOO ROAD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075
Practice Address - Country:US
Practice Address - Phone:410-799-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23561261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health