Organization
GARFIELD BEACH CVS LLC
Active
Other names
CVS Pharmacy #16294
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2355 W KETTLEMAN LN, LODI, CA 95242-4120
(209) 339-0232
(209) 371-2071
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
PHY54008
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992728299
—
CA
01
—
2113441
PK
—
Enumeration date
07/26/2006
Last updated
06/02/2017
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