Organization
CVS STATE CAPITAL, L.L.C.
Active
Other names
CVS Pharmacy 00143
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
384 ELM ST, BIDDEFORD, ME 04005-3012
(207) 282-3187
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, 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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157010005
—
ME
01
—
2008414
NCPDP
—
Enumeration date
08/31/2009
Last updated
03/05/2012
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