Organization
OHIO CVS STORES LLC
Active
Other names
CVS PHARMACY #02394
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, MANAGED CARE ADMIN)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1013 WASHINGTON BLVD, BELPRE, OH 45714-2363
(740) 401-1035
Mailing address
1 CVS DR, PO BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
02-112250
OH
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107311
OH MEDICAID RX PROVIDER #
OH
01
—
3666142
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
3810012609
—
WV
Enumeration date
09/12/2006
Last updated
12/20/2022
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