Organization
MARYLAND CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy # 07952
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (MANAGER, PHARMACY ENROLLMENTS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
630 EXETER ST, BALTIMORE, MD 21202
(410) 962-6520
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
—
017839000
—
MD
01
—
018326100
MD MEDICAID DME
MD
01
—
2133964
NCPDP #
—
Enumeration date
04/30/2008
Last updated
10/01/2014
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