Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY # 01811
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1504 3RD ST S, JACKSONVILLE BEACH, FL 32250-6312
(904) 246-7596
(904) 241-2297
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20404
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006178
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
105906800
—
FL
01
—
P00754232
MEDICARE RR
FL
Enumeration date
09/12/2006
Last updated
09/24/2012
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