Organization
KENTUCKY CVS PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SENIOR DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
157 SOUTH BUCKMAN STREET, SHEPHERDSVILLE, KY 40165
(502) 921-0094
Mailing address
1 CVS DR, BOX 1075, 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
—
1835593
NCPDP
KY
01
—
6031860077
MEDICARE PART B
KY
05
—
7100443660
—
KY
05
—
7100487570
—
KY
01
—
P300023924
MASS IMM
KY
Enumeration date
09/01/2016
Last updated
11/29/2017
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