Organization
GARFIELD BEACH CVS, L.L.C.
Active
Other names
CVS Pharmacy # 09787
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3943 SAN FERNANDO RD, GLENDALE, CA 91204
(818) 549-2270
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
PHY48236
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699872945
—
CA
01
—
5623752
NCPDP - OTHER COMMERCIAL IDENTIFIER
—
01
—
P00962113
MEDICARE - RR PIN
—
Enumeration date
09/20/2006
Last updated
03/09/2012
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