Provider Demographics
NPI:1174941249
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:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REMBLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:623-977-8260
Mailing Address - Street 1:9856 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6110
Mailing Address - Country:US
Mailing Address - Phone:623-977-8260
Mailing Address - Fax:623-876-0650
Practice Address - Street 1:9856 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6110
Practice Address - Country:US
Practice Address - Phone:623-977-8260
Practice Address - Fax:623-876-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty