Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #10163
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2410 8TH ST S, WISCONSIN RAPIDS, WI 54494-6159
(715) 423-2340
Mailing address
ONE CVS DRIVE, 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
—
1407298383
—
WI
01
—
5133842
NCPDP
—
Enumeration date
07/22/2013
Last updated
12/13/2013
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