# MARYLAND CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy\# 02777
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902100886
- **Authorized official:** SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 162 FLEET ST, OXON HILL, MD 20745-1575
- **Practice address phone:** (301) 686-0248
- **Mailing address:** 1 CVS DR, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500
- **Mailing address fax:** (401) 770-7108

## Taxonomy

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

## Other

- **Enumeration date:** 01/06/2011
- **Last updated:** 10/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0401412 00 RX | — | MD |
| 05 | — | 0401421 00 DME | — | MD |
| 01 | — | 2135588 | NCPDP | MD |