Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY # 05966
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1600 S FEDERAL HWY, HOLLYWOOD, FL 33020-6346
(954) 921-7747
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
05
—
003776200
—
FL
01
—
003776201
MEDICAID DME
FL
01
—
5705857
NCPDP
FL
01
—
PH25592
PHARMACY STATE LICENSE
FL
Enumeration date
05/12/2011
Last updated
03/07/2023
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