Organization
OKLAHOMA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY # 06142
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4500 N KICKAPOO AVE, SHAWNEE, OK 74804-1208
(405) 878-0244
(405) 878-0432
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
10-5261
OK
333600000X
Pharmacy
Primary
10-5261
OK
3336C0003X
Community/Retail Pharmacy
10-5261
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100239430B
STATE MEDICAID DME NUMBER
OK
01
—
3715577
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
90003921095
—
OK
Enumeration date
09/12/2006
Last updated
01/17/2023
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