# CVS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \#05994
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851657464
- **Authorized official:** SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
- **Authorized official phone:** (401) 765-1500

## Contact information

- **Practice address:** 1202 N RIVERSIDE DR, ESPANOLA, NM 87532-2976
- **Practice address phone:** (505) 367-3594
- **Mailing address:** 1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | PH00003410 | NM | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |

## Other

- **Enumeration date:** 04/09/2012
- **Last updated:** 10/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 26730031 | NM MEDICAID/DME | NM |
| 01 | — | 3212331 | NCPDP | — |
| 05 | — | 47737727 | — | NM |