MEDICARE: CARECENTER PHARMACY 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	3336S0011X	Specialty Pharmacy
4	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5131228	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407007669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARECENTER PHARMACY LLC

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	:	W165N 5595 CREEKWOOD CROSSING
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-5655
Country	:	US
Telephone Number	:	262-703-3386
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, PAYER RELATIONS
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/24/2014

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Directions to “CARECENTER PHARMACY LLC ” Practice Location

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