Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 02214
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
800 MAIN AVE, DEPERE, WI 54115
(920) 336-6373
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
—
1285989178
—
WI
01
—
5133246
NCPDP
—
01
—
9158
PHARMACY STATE LICENSE
WI
Enumeration date
07/17/2012
Last updated
03/07/2023
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