Organization
ARIZONA CVS STORES, L.L.C.
Active
Other names
CVS Pharmacy # 08977
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3501 STOCKTON HILL RD, KINGMAN, AZ 86409
(928) 757-1999
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
—
0356205
NCPDP
—
05
—
453620
—
AZ
Enumeration date
07/07/2009
Last updated
12/20/2022
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