Organization
PENNSYLVANIA CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy # 04007
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANA MAURICIO (MANAGER, PHARMACY ENROLLMENTS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3925 WALNUT ST, PHILADELPHIA, PA 19104-3624
(215) 222-0829
Mailing address
1 CVS DR, 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
—
1015538870026
—
PA
01
—
1801045190
PACE
PA
01
—
3991052
NCPDP
PA
Enumeration date
09/11/2008
Last updated
09/12/2014
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