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Organization
WISCONSIN CVS PHARMACY LLC
Active
Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 02214
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
800 MAIN AVE, DEPERE, WI 54115
(920) 336-6373
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
—
1285989178
—
WI
01
—
5133246
NCPDP
—
01
—
9158
PHARMACY STATE LICENSE
WI
Enumeration date
07/17/2012
Last updated
03/07/2023
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