Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY# 03703
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
10925 STATE ROAD 54, NEW PORT RICHEY, FL 34655
(727) 372-9030
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
—
000645000
—
FL
01
—
000645001
DME
FL
01
—
1040093
NCPDP
—
Enumeration date
11/20/2008
Last updated
03/20/2012
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