Organization
HOLIDAY CVS, L.L.C.
Active
Other names
CVS Pharmacy #04686
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
5590 N WICKHAM RD, MELBOURNE, FL 32940-7303
(321) 751-0090
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
—
001956500
—
FL
01
—
001956501
DME
FL
01
—
1053444
NCPDP
—
Enumeration date
02/15/2010
Last updated
10/21/2010
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