Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY 00574
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
8001 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33702-4109
(727) 577-6888
(727) 576-6226
Mailing address
1 CVS DR, PO 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
20390
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1004629
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
105986600
—
FL
Enumeration date
09/12/2006
Last updated
08/23/2012
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