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NPI Code Detail

MEDICARE: WOODWARD DETROIT CVS LLC

MEDICARE: WOODWARD DETROIT CVS 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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy5301010836MI
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12044712OTHERPK

General Provider Information

NPI Number : 1346262011
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODWARD DETROIT CVS LLC
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 :
Provider Business Practice Location Address
First Line : 5609 W SAGINAW HWY
Second Line :
City : LANSING
State : MI
Zip : 48917-2456
Country : US
Telephone Number : 517-327-0620
Fax Number : 517-318-0644
Authorized Official
Title or Position : SR. DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 07/24/2006
Last Update Date : 09/26/2016

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