Organization
MISSISSIPPI CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy #05604
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
5025 HIGHWAY 305 N, OLIVE BRANCH, MS 38654-3602
(662) 890-3548
Mailing address
ONE CVS DRIVE, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895
(401) 765-1500
(401) 770-7108
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
05
—
03337761
—
MS
01
—
07158876
MEDICAID DME
MS
01
—
2587915
NCPDP
—
Enumeration date
01/22/2010
Last updated
03/01/2012
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