Organization
WISCONSIN CVS PHARMACY, LLC
Active
Other names
CVS Pharmacy # 08947
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1130 W SUNSET DR, WAUKESHA, WI 53189-8422
(262) 446-5169
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
—
1235362328
—
WI
01
—
5131723
NCPDP
—
Enumeration date
08/24/2009
Last updated
03/10/2011
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