Organization
OKLAHOMA CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #02489
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
100 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-4207
(405) 741-0036
(405) 741-0032
Mailing address
1 CVS DR, 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200113030G
—
OK
01
—
200113030H
MEDICAID DME
OK
01
—
3725883
NCPDP #
—
Enumeration date
08/13/2009
Last updated
11/07/2014
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