Organization
MARYLAND CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 04220
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2311 HANOVER PIKE, HAMPSTEAD, MD 21074
(410) 239-3750
Mailing address
1 CVS DR, PO 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
P00617
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110714
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
746346400
—
MD
01
—
795006300
STATE MEDICAID DME NUMBER
MD
Enumeration date
09/07/2006
Last updated
11/25/2011
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