Organization
PENNSYLVANIA CVS PHARMACY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIR PHCY ENROLLMENTS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
620 MARKET ST, KINGSTON, PA 18704-4541
(670) 331-4011
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PP415223L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3972456
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P00754726
MEDICARE RR
—
Enumeration date
09/12/2006
Last updated
10/25/2017
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