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NPI Code Detail

MEDICARE: GEORGIA CVS PHARMACY LLC

MEDICARE: GEORGIA CVS PHARMACY LLC
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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical SuppliesGA
3333600000XPharmacy007838GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11141352OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336242890
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA CVS PHARMACY 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 : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 1043 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-6719
Country : US
Telephone Number : 404-767-2034
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/07/2006
Last Update Date : 09/08/2011

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Directions to “GEORGIA CVS PHARMACY LLC ” Practice Location

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