Organization
KANSAS CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy #05889
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
400 SOUTH 10TH STREET, ATCHISON, KS 66002
(913) 367-1518
(913) 367-1558
Mailing address
1 CVS DR, BOX 1075-PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
1720007
NCPDP
—
05
—
200602180Q
—
KS
01
—
200602180R
MEDICAID DME
KS
Enumeration date
01/26/2010
Last updated
10/25/2011
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