Organization
NORTH CAROLINA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #07578
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, MANAGED CARE ADMIN)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3658 SOUTH NEW HOPE RD, GASTONIA, NC 28056
(704) 823-1838
(704) 823-1839
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
05
—
0366423
—
NC
05
—
1558593822
—
SC
01
—
3416268
NCPDP #
NC
01
—
7705083
MEDICAID DME
NC
Enumeration date
08/19/2009
Last updated
08/13/2013
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