Organization
KENTUCKY CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #17524
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4174 WESTPORT RD, LOUISVILLE, KY 40207-2735
(502) 992-1040
(502) 992-1050
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
P07742
KY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121439
PK
—
Enumeration date
08/13/2009
Last updated
10/25/2016
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