Organization
CVS STATE CAPITAL LLC
Active
Other names
CVS Pharmacy #17382
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
119 CROSSING WAY, AUGUSTA, ME 04330-6102
(207) 622-8001
(207) 622-8011
Mailing address
1 CVS DR, BOX 1075, 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
PH50001547
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2037655
PK
—
Enumeration date
01/16/2008
Last updated
10/31/2016
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