Organization
CVS PHARMACY INC
Active
Other names
CVS Pharmacy # 04879
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
827 E MILAM ST, MEXIA, TX 76667-2447
(254) 472-0306
Mailing address
1 CVS DR, P O BOX 1075 - PROVIDER ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
TX
333600000X
Pharmacy
Primary
—
TX
3336C0003X
Community/Retail Pharmacy
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217114201
DME
TX
05
—
466707
—
TX
01
—
5900534
NCPDP
TX
Enumeration date
07/16/2010
Last updated
10/05/2011
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