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Organization
CVS STATE CAPITAL, L.L.C.
Active
Organization
CVS STATE CAPITAL, L.L.C.
Active
Other names
CVS Pharmacy 00143
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
384 ELM ST, BIDDEFORD, ME 04005-3012
(207) 282-3187
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
157010005
—
ME
01
—
2008414
NCPDP
—
Enumeration date
08/31/2009
Last updated
03/05/2012
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