Organization
CONNECTICUT CVS PHARMACY LLC
Active
Other names
CVS PHARMACY# 05703
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
60 MIDDLE STREET, BRISTOL, CT 06010-5201
(860) 585-0122
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
—
008034913
—
CT
01
—
008037400
DME
CT
01
—
0722529
NCPDP
—
Enumeration date
08/17/2011
Last updated
03/11/2014
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