Organization
WISCONSIN CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY # 10533
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR.DIRECTOR-PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3915 DURAND AVE, ELMWOOD PARK, WI 53405-4402
(262) 554-0035
Mailing address
ONE CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
WI
333600000X
Pharmacy
Primary
—
WI
3336C0003X
Community/Retail Pharmacy
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245615640
—
WI
01
—
5134919
NCPDP
WI
Enumeration date
07/27/2015
Last updated
11/16/2015
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