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NPI Code Detail

MEDICARE: GEORGIA CVS PHARMACY, L.L.C.

MEDICARE: GEORGIA CVS PHARMACY, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesPHRE009099GA
23336C0003XCommunity/Retail PharmacyGA
3333600000XPharmacyPHRE009099GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11155060OTHERGANCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033271333
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA CVS PHARMACY, L.L.C.
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number : 401-770-7108
Provider Business Practice Location Address
First Line : 100 PIEDMONT RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-3636
Country : US
Telephone Number : 770-795-9844
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 12/14/2006
Last Update Date : 03/07/2012

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