Organization
CVS PHARMACY INC
Active
Other names
CVS PHARMACY #05494
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN F COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1500 TRAMWAY BLVD NE, ALBUQUERQUE, NM 87112-6198
(505) 296-4803
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
01
—
01086227
NM MEDICAID - DME
NM
01
—
3212141
NCPDP
—
05
—
53237226
—
NM
Enumeration date
05/16/2011
Last updated
01/18/2012
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