Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 10825
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (SR. DR. PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2400 BUTLER PIKE, PLYMOUTH MEETING, PA 19462
(610) 941-1291
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
01
—
5619370478
MEDICARE B
PA
01
—
6005169
NCPDP #
PA
Enumeration date
04/14/2017
Last updated
02/01/2021
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