Organization
ARKANSAS CVS PHARMACY L.L.C.
Active
Other names
CVS PHARMACY #10019
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3908 N STATE LINE AVE, TEXARKANA, AR 71854-1935
(870) 772-0236
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
01
—
0424046
NCPDP
—
05
—
194388407
—
AR
01
—
195951716
MEDICAID DME
—
01
—
AR20686
PHARMACY STATE LICENSE
—
Enumeration date
08/15/2012
Last updated
03/07/2023
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