# MAIN STREET PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#48364
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942300223
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 4800 FILLMORE AVE, ALEXANDRIA, VA 22311-5070
- **Practice address phone:** (703) 824-1352
- **Practice address fax:** (703) 824-1353
- **Mailing address:** 1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 03/07/2019