Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY #04069
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
4725 N OCEAN DR, LAUDERDALE BY THE SEA, FL 33308-2914
(954) 942-8648
(954) 942-8318
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
20189
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105720100
—
FL
01
—
1067633
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P00754232
MEDICARE RR
—
Enumeration date
09/12/2006
Last updated
08/16/2021
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