Organization
WISCONSIN CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY # 10549
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR-PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1108 N 14TH ST, SHEBOYGAN, WI 53081-3213
(920) 452-0079
Mailing address
BOX 1075, ONE CVS DRIVE, 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
01
—
100047841
WI ADAP
WI
05
—
100047841
—
WI
01
—
5134868
NCPDP
WI
Enumeration date
06/15/2015
Last updated
11/04/2015
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