Organization
PENNSYLVANIA CVS PHARMACY, LLC
Active
Other names
CVS PHAMACY # 17680
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
749 N KROCKS RD, ALLENTOWN, PA 18106-9076
(610) 366-1103
Mailing address
1 CVS DR, BOX 1075, 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
—
1015538870517
—
PA
01
—
6003862
NCPDP
PA
Enumeration date
05/16/2016
Last updated
10/19/2016
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