Organization
MAIN STREET PHARMACY, LLC
Active
Other names
CVS Pharmacy #48271
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
715 MAIDEN CHOICE LN, BALTIMORE, MD 21228-5999
(410) 737-8820
(410) 737-8829
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
P05174
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120246
NCPDP
—
05
—
341552000
—
MD
Enumeration date
09/15/2006
Last updated
03/02/2022
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