Organization
NEW JERSEY CVS PHARMACY LLC
Active
Other names
CVS Pharmcy #00638
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
74 SOUTH LAKEVIEW DRIVE, GIBBSBORO, NJ 08026
(856) 783-6328
Mailing address
1 CVS DR, BOX 1075, 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
05
—
0146943
—
NJ
01
—
0163112
NJ MEDICAID DME #
NJ
01
—
3194696
NCPDP
NJ
Enumeration date
09/07/2007
Last updated
10/29/2010
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