Organization
MISSISSIPPI CVS PHARMACY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
25820 W MAIN ST, WEST POINT, MS 39773-2763
(662) 494-4990
Mailing address
1 CVS DR, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
07555063
—
MS
01
—
2587066
NCPDP
—
01
—
5983700003
MEDICARE B
MS
Enumeration date
01/07/2008
Last updated
01/10/2023
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