Provider Demographics
NPI:1164619201
Name:TENNESSEE CVS PHARMACY,L.L.C.
Entity Type:Organization
Organization Name:TENNESSEE CVS PHARMACY,L.L.C.
Other - Org Name:CVS PHARMACY #02198
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR, RX SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX1075 PROVIDER ENROLLMENTS
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-765-1500
Mailing Address - Fax:401-770-7108
Practice Address - Street 1:1078 EAST 10TH STREET
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1908
Practice Address - Country:US
Practice Address - Phone:931-372-7425
Practice Address - Fax:931-372-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523289OtherDME MEDICAID
TN4440676OtherNCPDP #
P00965803Medicare PIN
TN1523289OtherDME MEDICAID
TN5777660004Medicare NSC