Organization
HOOK- SUPERX, L.L.C.
Active
Other names
CVS Pharmacy # 05696
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
10170 ILLINOIS RD, FORT WAYNE, IN 46804-5774
(260) 436-6021
Mailing address
ONE CVS DRIVE, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IN
333600000X
Pharmacy
Primary
—
IN
3336C0003X
Community/Retail Pharmacy
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1562683
NCPDP
IN
05
—
200944210 A
—
IN
Enumeration date
05/14/2009
Last updated
10/23/2015
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