Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY 00652
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR)
(401) 770-2751
Entity
Organization
Contact information
Practice address
57 TUSCAN WAY, SAINT AUGUSTINE, FL 32092
(904) 940-3817
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
—
032595300
—
FL
01
—
032595301
FL DME
FL
01
—
1032349
NCPDP
FL
Enumeration date
01/24/2008
Last updated
09/23/2011
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