Organization
UTAH CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #17596
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1110 S 300 W, SALT LAKE CITY, UT 84101-3053
(801) 401-9563
(801) 401-9564
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
9610047-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126181
PK
—
Enumeration date
08/11/2010
Last updated
11/30/2016
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