Organization
HOOK-SUPERX LLC
Active
Other names
CVS Pharmacy# 10190
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
770 E DUPONT RD, FORT WAYNE, IN 46825-2056
(260) 451-8242
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
(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
—
1564966
NCPDP
—
05
—
201213420A
—
IN
Enumeration date
12/02/2013
Last updated
04/22/2014
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