MEDICARE: ARIZONA CVS STORES LLC

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	0353742	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1326082678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA CVS STORES LLC

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

Provider Business Practice Location Address
First Line	:	522 W FINNIE FLAT RD
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-7265
Country	:	US
Telephone Number	:	928-567-2274
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PHARMACY ENROLLMENTS
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/10/2018

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Directions to “ARIZONA CVS STORES LLC ” Practice Location

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