Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY # 02589
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
558 PITTSBURGH ST, MARS, PA 16046-2608
(724) 625-5577
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
05
—
1015538870383
—
PA
01
—
1154614279
PACE
PA
01
—
3995529
NCPDP
PA
Enumeration date
05/23/2011
Last updated
11/16/2011
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