Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY # 10090
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR,PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
2132 SOUTH ST, PHILADELPHIA, PA 19146-1227
(401) 765-1500
Mailing address
1 CVS DR, BOX 1075, 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
—
1015538870409
—
PA
01
—
16092126382
PACE
PA
01
—
3998018
NCPDP
PA
Enumeration date
09/11/2012
Last updated
05/31/2013
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