Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY 05169
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PHCY ENROLLMENTS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
100 2ND AVE SE, JASPER, FL 32052-6114
(386) 792-2551
(386) 792-3577
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20642
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105940800
—
FL
01
—
1079171
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/12/2006
Last updated
11/21/2012
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