Provider Demographics
NPI: | 1215602339 |
---|---|
Name: | CVS PHARMACY INC |
Entity Type: | Organization |
Organization Name: | CVS PHARMACY INC |
Other - Org Name: | CVS PHARMACY #17766 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | SR. DIRECTOR PAYER RELATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | F |
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: | BOX 1075 |
Mailing Address - City: | WOONSOCKET |
Mailing Address - State: | RI |
Mailing Address - Zip Code: | 02895-6146 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 289 HANCOCK ST |
Practice Address - Street 2: | |
Practice Address - City: | QUINCY |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02171-2229 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-691-1040 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-08-11 |
Last Update Date: | 2021-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |