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Organization
HOOK-SUPERX LLC
Active
Organization
HOOK-SUPERX LLC
Active
Other names
CVS Pharmacy #17294
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3801 COLDWATER RD, FORT WAYNE, IN 46805-1101
(260) 470-6361
(260) 470-6371
Mailing address
1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200844790A
—
IN
01
—
2025470
PK
—
Enumeration date
09/25/2006
Last updated
08/24/2016
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