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Organization
MISSISSIPPI CVS PHARMACY, L.L.C.
Active
Organization
MISSISSIPPI CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy #04536
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
301 AMERICAN AVE, BOONEVILLE, MS 38829-1001
(662) 720-1707
Mailing address
1 CVS DR, BOX 1075-PHARMACY ENROLLMENTS, 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
—
01880069
—
MS
01
—
07609070
MEDICAID DME
MS
01
—
2588119
NCPDP
—
Enumeration date
08/24/2010
Last updated
01/17/2023
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