Organization
MARYLAND CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY # 10565
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR-PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3200 ST. PAUL ST., BALTIMORE, MD 21218
(410) 243-1025
Mailing address
1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MD
333600000X
Pharmacy
Primary
—
MD
3336C0003X
Community/Retail Pharmacy
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112378500
—
MD
01
—
1123815 00
DME
MD
01
—
2140325
NCPDP
MD
Enumeration date
06/21/2016
Last updated
12/20/2016
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