Organization
MARYLAND CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #01501
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
19100 MONTGOMERY VILLAGE AVE, GAITHERSBURG, MD 20886-3701
(301) 948-9886
Mailing address
1 CVS DR, PO BOX 1075, 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
P00559
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013582800
—
MP
01
—
2101183
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
295778701
MEDICAID DME
MD
05
—
3654052 00
—
MD
Enumeration date
09/12/2006
Last updated
11/15/2010
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