Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #04996
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
N83 W15550 APPLETON AVENUE, MENOMONEE FALLS, WI 53051
(262) 253-5056
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(262) 253-5056
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
—
1396014908
—
WI
01
—
5132977
NCPDP
WI
01
—
9112-42
PHARMACY STATE LICENSE
WI
Enumeration date
12/28/2011
Last updated
03/07/2023
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