Organization
WISCONSIN CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #16654
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
4798 S MOORLAND RD, NEW BERLIN, WI 53151-7486
(262) 207-0021
(262) 207-0021
Mailing address
1 CVS DR, MAIL CODE 1090, 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
7994042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109766
PK
—
Enumeration date
07/24/2006
Last updated
12/13/2016
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