Organization
WOODWARD DETROIT CVS LLC
Active
Other names
CVS PHARMACY # 06843
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
626 WEST FRONT ST, TRAVERSE CITY, MI 49684-2210
(231) 935-0185
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
—
1386992204
—
MI
01
—
2377100
NCPDP
MI
01
—
5603870249
MEDICATE NSC
MI
Enumeration date
08/27/2012
Last updated
07/21/2022
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