Organization
KANSAS CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 04521
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
22700 W 55TH TERRACE, SHAWNEE, KS 66226
(401) 765-1500
Mailing address
ONE CVS DRVIE, 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
01
—
1719458
NCPDP
—
05
—
200384100U
—
KS
Enumeration date
06/09/2008
Last updated
09/30/2014
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