Organization
GEORGIA CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy #05051
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
4250 ROSWELL RD, MARIETTA, GA 30062-6498
(770) 565-4064
(401) 770-7108
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE009105
GA
333600000X
Pharmacy
Primary
PHRE009105
GA
3336C0003X
Community/Retail Pharmacy
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1155250
NCPDP
GA
05
—
187091326A
—
GA
Enumeration date
12/29/2006
Last updated
10/24/2011
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