Organization
NEBRASKA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY # 05863
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
14460 W MAPLE RD, OMAHA, NE 68116-5163
(402) 493-0443
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
—
10025882600
—
NE
01
—
2817976
NCPDP
—
Enumeration date
06/16/2010
Last updated
03/13/2012
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