Organization
PENNSYLVANIA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 03062
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3192 ROUTE 115, EFFORT, PA 18330
(570) 688-2302
Mailing address
ONE CVS DRIVE, WOONSOCKET, RI 02895
(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
—
1015538870382
—
PA
01
—
1790079275
PACE
PA
01
—
3995567
NCPDP
PA
Enumeration date
06/02/2011
Last updated
06/26/2014
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