Provider Demographics
NPI:1891899860
Name:ALABAMA CVS PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:ALABAMA CVS PHARMACY, L.L.C.
Other - Org Name:CVS PHARMACY #02505
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PAYER RELATIONS
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:BOX 1075
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:401-735-1080
Practice Address - Street 1:93 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BROOK
Practice Address - State:AL
Practice Address - Zip Code:35213-3701
Practice Address - Country:US
Practice Address - Phone:205-871-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
AL111339333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1891899860OtherAL MEDICAID DME #
0128733OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL1891899860Medicaid
5613080113Medicare NSC
510G730021Medicare PIN