Organization
PENNSYLVANIA CVS PHARMACY, L.L.C
Active
Other names
CVS PHARMACY #17696
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DR. PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
7162 RIDGE AVE, PHILADELPHIA, PA 19128-3250
(215) 483-2124
Mailing address
1 CVS DR, 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
—
1015538870529
—
PA
01
—
6004826
NCPDP
PA
Enumeration date
01/11/2017
Last updated
05/03/2017
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