Provider Demographics
NPI:1861894941
Name:CVS CAREMARK MINUTECLINIC
Entity type:Organization
Organization Name:CVS CAREMARK MINUTECLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAINE-PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-9323
Mailing Address - Street 1:3345 HARRIET AVE # 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3729
Mailing Address - Country:US
Mailing Address - Phone:612-702-0890
Mailing Address - Fax:
Practice Address - Street 1:15051 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6987
Practice Address - Country:US
Practice Address - Phone:952-432-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2014010271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty