Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY #05157
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1300 SW ST LUCIE BLVD, PORT SAINT LUCIE, FL 34986
(772) 878-7078
(772) 343-0608
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20592
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106175500
—
FL
01
—
1080439
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/19/2006
Last updated
01/17/2023
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