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Organization

MISSISSIPPI CVS PHARMACY, L.L.C

Active
Other names
CVS Pharmacy #04993
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization

Contact information

Practice address
1014 HIGHWAY 51, MADISON, MS 39110-8304
(601) 856-2021
Mailing address
1 CVS DRIVE, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895
(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
00888740
MS
01
08420042
MEDICAID DME
MS
01
2587826
NCPDP
MS
Enumeration date
09/22/2009
Last updated
08/22/2014
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