Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY #03103
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
327 NE US HIGHWAY 19, CRYSTAL RIVER, FL 34429-4234
(352) 795-7262
(352) 564-2885
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20547
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1026904
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
105778200
—
FL
01
—
P00754232
MEDICARE RR
—
Enumeration date
09/12/2006
Last updated
11/06/2012
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