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Organization
MISSISSIPPI CVS PHARMACY LLC
Active
Organization
MISSISSIPPI CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #06396
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
800 E FIFTEENTH ST, YAZOO CITY, MS 39194-7625
(662) 751-8580
Mailing address
1 CVS DR, BOX 1075, 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
—
03955786
—
MS
01
—
08909748
MEDICAID DME
MS
01
—
2588587
NCPDP
—
Enumeration date
11/28/2011
Last updated
08/09/2012
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