Organization
CVS STATE CAPITAL, L.L.C.
Active
Other names
CVS Pharmacy #07410
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
48 PORTLAND RD, KENNEBUNK, ME 04043-6631
(207) 467-8299
Mailing address
1 CVS DR, BOX 1075 PHARMACY ENROLLMENTS, 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
—
157010004
—
ME
01
—
2008349
NCPDP
—
Enumeration date
03/25/2009
Last updated
06/18/2014
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