Organization
GEORGIA CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy # 04730
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1187 GRAYSON HWY, LAWRENCEVILLE, GA 30045
(770) 338-2513
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
—
053554458A
—
GA
01
—
1157278
NCPDP
GA
Enumeration date
04/29/2008
Last updated
03/07/2012
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