Organization
WEST VIRGINIA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy 04207
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (EXEC DIR, RX SERVICES)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4205 MACCORKLE AVE SE, CHARLESTON, WV 25304-2501
(304) 925-0786
(304) 925-1017
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
—
3810016060
—
WV
01
—
5055098
NCPDP
—
Enumeration date
08/06/2009
Last updated
01/17/2023
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