Organization
HOLIDAY CVS LLC
Active
Other names
CVS PHARMACY # 01817
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR PHCY ENROLLMENTS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2233 W US HIGHWAY 90, LAKE CITY, FL 32055-4761
(386) 752-8090
(386) 755-4116
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
FL
333600000X
Pharmacy
Primary
20313
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006116
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
105727800
—
FL
Enumeration date
09/12/2006
Last updated
11/06/2012
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