Organization
VIRGINIA CVS PHARMACY LLC
Active
Other names
CVS Pharmacy # 10453
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
12755 JEFFERSON AVE, NEWPORT NEWS, VA 23602-4317
(757) 877-3147
Mailing address
1 CVS DR, BOX 1075- PHARMACY ENROLLMENT, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
1912307760
—
VA
01
—
4845775
NCPDP
VA
Enumeration date
08/29/2014
Last updated
12/31/2014
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