Organization
OKLAHOMA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 07971
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
10101 S MEMORIAL DR., TULSA, OK 74133
(918) 369-4911
(918) 369-4916
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
—
OK
333600000X
Pharmacy
Primary
—
OK
3336C0003X
Community/Retail Pharmacy
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200113030L
—
OK
01
—
200113030M
MEDICAID DME
OK
01
—
3725833
NCPDP
OK
Enumeration date
07/23/2009
Last updated
11/07/2013
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