Organization
HOLIDAY CVS, L.L.C.
Active
Other names
CVS Pharmacy# 07173
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
6651 N. MILITARY TRAIL, SUITE 100, BOCA RATON, FL 33496
(561) 998-3747
Mailing address
1 CVS DR, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
—
002346300
—
FL
01
—
002346301
DME
FL
01
—
5700364
NCPDP
—
Enumeration date
06/10/2010
Last updated
09/27/2011
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