Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY# 07964
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PHARMACY ENROLLMENTS)
(401) 765-2751
Entity
Organization
Contact information
Practice address
2301 MOODY BLVD, FLAGLER BEACH, FL 32136
(386) 439-0271
Mailing address
1 CVS DR, 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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000670700
—
FL
01
—
000670701
DME
FL
01
—
1041829
NCPDP
—
Enumeration date
01/20/2009
Last updated
09/24/2012
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