Organization
MISSISSIPPI CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #00047
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
12024 LAMEY BRIDGE RD, DIBERVILLE, MS 39540-8906
(228) 396-2858
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00323510
—
MS
01
—
04484010
MEDICAID DME
MS
01
—
2588830
NCPDP
—
Enumeration date
06/11/2012
Last updated
04/17/2013
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