Organization
IDAHO CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #17284
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
16300 N MARKETPLACE BLVD, NAMPA, ID 83687-7910
(208) 465-6801
(208) 465-6811
Mailing address
1 CVS DR, BOX 1075, 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
41103RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021945
PK
—
Enumeration date
09/25/2006
Last updated
11/21/2016
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