Organization
PENNSYLVANIA CVS PHARMACY, LLC
Active
Other names
CVS PHARMACY # 02170
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3331 GRANT AVE, PHILADELPHIA, PA 19114-2629
(215) 464-2636
Mailing address
1 CVS DR, 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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015538870438
—
PA
01
—
6000448
NCPDP
PA
Enumeration date
04/24/2014
Last updated
03/11/2015
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