Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY #05194
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA VANDERBRUG (PHCY ENROLLMENTS REPRESENTATIVE)
(401) 770-1624
Entity
Organization
Contact information
Practice address
1081 BEAL PKWY NW, FORT WALTON BEACH, FL 32547-1439
(850) 863-4400
(850) 863-4445
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
20534
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021527900
—
FL
01
—
1086695
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/12/2006
Last updated
12/04/2012
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