Organization
HOOK-SUPERX LLC
Active
Other names
CVS Pharmacy #18076, SCHNUCKS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4500 W LLOYD EXPY, EVANSVILLE, IN 47712-6515
(812) 422-6399
(812) 422-6492
Mailing address
1 CVS DR # 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
60003942A
IN
333600000X
Pharmacy
60003942A
IN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100302180A
—
IN
01
—
1527235
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/17/2006
Last updated
02/19/2024
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