Organization
KENTUCKY CVS PHARMACY LLC
Active
Other names
CVS PHARMACY # 07940
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1221 FREDERICA ST, OWENSBORO, KY 42301
(270) 683-5086
Mailing address
ONE CVS DRIVE, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
KY
333600000X
Pharmacy
Primary
—
KY
3336C0003X
Community/Retail Pharmacy
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1830404
OTHER COMMERCIAL IDENTIFIER - NCPDP
—
05
—
710001547000
—
KY
01
—
710002583000
MEDICAID - DME
KY
Enumeration date
10/11/2007
Last updated
01/18/2023
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