Provider Demographics
NPI:1245428416
Name:VIRGINIA CVS PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:VIRGINIA CVS PHARMACY, L.L.C.
Other - Org Name:CVS PHARMACY # 06852
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, PHARMACY ENROLLMENTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-765-1500
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075- PHARMACY 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 1:16712 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026
Practice Address - Country:US
Practice Address - Phone:703-221-7467
Practice Address - Fax:401-770-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245428416 RX-DMEMedicaid
VA4840547OtherNCPDP
00100FMedicare PIN
VA1245428416 RX-DMEMedicaid