Organization
MAIN STREET PHARMACY, LLC
Active
Other names
CVS Pharmacy #48273
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
8800 WALTHER BLVD, PARKVILLE, MD 21234-9001
(410) 882-3238
(410) 882-3188
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
PO2067
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121983
NCPDP
—
05
—
432236300
—
MD
Enumeration date
09/25/2006
Last updated
08/01/2016
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