# WISCONSIN CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \#05535
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952678591
- **Authorized official:** SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 605 W. COTTAGE GROVE RD., COTTAGE GROVE, WI 53527-9222
- **Practice address phone:** (608) 839-3704
- **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 | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/28/2011
- **Last updated:** 03/07/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1952678591 | — | WI |
| 01 | — | 5132903 | NCPDP | WI |
| 01 | — | 9102-42 | PHARMACY STATE LICENSE | WI |