Organization
UTAH CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY # 10424
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR-PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
5557 W 4100 S, WEST VALLEY CITY, UT 84120-4629
(801) 966-1118
Mailing address
1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
UT
333600000X
Pharmacy
Primary
—
UT
3336C0003X
Community/Retail Pharmacy
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124475108
—
UT
01
—
4613584
NCPDP
UT
Enumeration date
05/19/2016
Last updated
04/03/2019
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