Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #04380
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1736 W. 9TH AVE., OSHKOSH, WI 54902
(920) 235-6664
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
05
—
1508299926
—
WI
01
—
5133880
NCPDP
—
Enumeration date
08/21/2013
Last updated
01/08/2014
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