Organization
MISSISSIPPI CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy # 11085
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (SR. DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
575 CRAFT AVE, HOLLY SPRINGS, MS 38635-3249
(662) 252-2285
(662) 252-2394
Mailing address
ONE CVS DRIVE BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MS
333600000X
Pharmacy
Primary
—
MS
3336C0003X
Community/Retail Pharmacy
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330511
—
MS
01
—
2516269
NCPDP
MS
01
—
302G735488
MASS IMM
MS
01
—
5983700059
MEDICARE B
MS
Enumeration date
09/22/2006
Last updated
07/21/2022
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