Organization
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Active
Other names
CVS Pharmacy #01200
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1002 SAMS CROSSING ROAD, COLUMBIA, SC 29229
(803) 788-0535
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
—
1992965263
—
SC
01
—
4227775
NCPDP #
—
01
—
710053
SC MED RX LEGACY #
—
01
—
DE3143
SC MEDICAID DME LEGACY #
SC
Enumeration date
06/11/2008
Last updated
11/19/2010
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