Organization
OKLAHOMA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #07972
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4107 S HARVARD AVE, TULSA, OK 74135-2601
(918) 747-6690
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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200289490A
MEDICAID DME
OK
05
—
200289490B
—
OK
01
—
3726126
NCPDP
—
Enumeration date
03/15/2010
Last updated
11/08/2010
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