Organization
CVS STATE CAPITAL. L.L.C.
Active
Other names
CVS Pharmacy #04158
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
24 STONE ST STE 120, AUGUSTA, ME 04330-5209
(401) 765-1500
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
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
—
157010003
—
ME
01
—
2008286
NCPDP
—
Enumeration date
09/26/2008
Last updated
07/07/2015
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