Organization
GEORGIA CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy # 00060
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
7300 GA HIGHWAY 21, PORT WENTWORTH, GA 31407-9205
(912) 964-1797
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
—
340306916H
—
GA
01
—
7G9390
SC MEDICAID
—
01
—
DE3491
DME SC MEDICAID
—
Enumeration date
08/28/2007
Last updated
07/23/2013
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