Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY# 01120
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (PHCY ENROLLMENTS REP)
(401) 770-2751
Entity
Organization
Contact information
Practice address
215 JACARANDA BLVD, VENICE, FL 34292
(941) 485-8393
Mailing address
1 CVS DR, BOX 1075-PHARMACY ENROLLMETNS, 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
—
000755700
—
FL
01
—
1041538
NCPDP
—
Enumeration date
01/15/2009
Last updated
09/23/2011
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