Organization
HOLIDAY CVS, L.L.C.
Active
Other names
CVS Pharmacy # 05410
Organization subpart
No
Provider details
NPI number
Authorized official
SUE COLBERT (DIRECTOR, MANAGED CARE)
(401) 765-1500
Entity
Organization
Contact information
Practice address
4478 TAMIAMI TRL, PORT CHARLOTTE, FL 33980-2931
(941) 235-1120
Mailing address
1 CVS DR, BOX 1075- PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
—
1050917
NCPDP
—
Enumeration date
12/03/2009
Last updated
03/16/2012
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