Organization
CVS PHARMACY INC
Active
Other names
CVS PHARMACY #05994
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1202 N RIVERSIDE DR, ESPANOLA, NM 87532-2976
(505) 367-3594
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH00003410
NM
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26730031
NM MEDICAID/DME
NM
01
—
3212331
NCPDP
—
05
—
47737727
—
NM
Enumeration date
04/09/2012
Last updated
10/31/2012
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