Organization
KENTUCKY CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 10205
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4894 N MAIN ST, EMINENCE, KY 40019-1018
(502) 845-5027
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
01
—
1833765
NCPDP
KY
05
—
7100253810
—
KY
05
—
7100277540 DME
—
KY
Enumeration date
06/27/2013
Last updated
04/14/2014
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