MEDICARE: ARIZONA CVS STORES, L.L.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0356370	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093048761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA CVS STORES, L.L.C.

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	BOX 1075 - PHARMACY ENROLLMENTS
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4744 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9377
Country	:	US
Telephone Number	:	928-763-6822
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PAYER RELATIONS
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-765-1500

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	06/18/2014

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Directions to “ARIZONA CVS STORES, L.L.C. ” Practice Location

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