Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #05709
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
405 W DUBOIS AVE, DUBOIS, PA 15801
(814) 371-9480
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PP412713L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3943152
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/26/2006
Last updated
02/13/2017
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