Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
Target Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
750 HILLDALE WAY, MADISON, WI 53705-2644
(608) 807-3979
(608) 807-3989
Mailing address
1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9060-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538463492
—
WI
01
—
2128274
PK
—
Enumeration date
01/06/2011
Last updated
01/11/2016
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