Organization
WISCONSIN CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy# 06855
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
17165 W BLUEMOUND RD, BROOKFIELD, WI 53005-5917
(262) 797-9074
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
—
1336463124
—
WI
01
—
5132179
NCPDP
WI
Enumeration date
03/23/2010
Last updated
03/07/2014
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