Organization
NEW JERSEY CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 06872
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
725 STATE ROUTE 10, RANDOLPH, NJ 07869
(973) 895-3401
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
RS00662300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115924
—
NJ
01
—
0163015
NJ MEDICAID DME #
NJ
01
—
3193581
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
11/17/2010
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