Organization
CVS PHARMACY INC
Active
Other names
CVS PHARMACY 07419
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1279 W MAIN STREET, GUN BARREL CITY, TX 75156
(903) 887-6498
(903) 887-3136
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
24700
TX
333600000X
Pharmacy
Primary
24700
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169247701
MEDICAID DME
TX
01
—
4566999
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
465867
—
TX
Enumeration date
12/06/2006
Last updated
03/03/2015
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