Organization
OKLAHOMA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #08279
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, MANAGED CARE ADMIN)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2351 N 9TH ST, BROKEN ARROW, OK 74012
(918) 355-1293
(918) 355-1361
Mailing address
ONE 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
01
—
200113030J
MEDICAID DME
OK
05
—
200113030K
—
OK
01
—
3726051
NCPDP
—
Enumeration date
01/26/2010
Last updated
10/31/2013
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