Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY #05912
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1891 LPGA BLVD, DAYTONA BEACH, FL 32117-7108
(386) 274-1490
Mailing address
1891 LPGA BLVD, DAYTONA BEACH, FL 32117-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022603
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/20/2006
Last updated
12/11/2012
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