Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 04066
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1706 THEATRE ST, LATROBE, PA 15650-9011
(724) 537-5571
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
PP410777L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3937010
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/07/2006
Last updated
12/07/2018
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