Organization
HOOK-SUPERX LLC
Active
Other names
CVS Pharmacy #07541
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
5981 WEST BROADWAY, MC CORDSVILLE, IN 46055
(317) 335-3380
(401) 770-7108
Mailing address
1 CVS DR, 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
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1561720
NCPDP
IN
05
—
200870610A
—
IN
01
—
202439
CHILDREN SPECIAL SERVICES
IN
Enumeration date
06/29/2007
Last updated
02/19/2024
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