Organization
CVS PHARMACY INC.
Active
Other names
CVS Pharmacy #16367
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4900 E MAIN ST, FARMINGTON, NM 87402-8658
(505) 327-3555
(505) 608-3482
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
PH00004174
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16475810
—
NM
01
—
2059009
PK
—
01
—
32557515
NM MEDICAID (DME)
NM
Enumeration date
10/19/2006
Last updated
12/22/2016
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