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NPI Code Detail

MEDICARE: HOLIDAY CVS LLC

MEDICARE: HOLIDAY 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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy20648FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11004782OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417051491
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOLIDAY CVS 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 : 737 CAPE CORAL PKWY E
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-8551
Country : US
Telephone Number : 239-542-0512
Fax Number : 239-542-1503
Authorized Official
Title or Position : MGR PHCY ENROLLMENTS
Name : CRISTIANA MAURICIO
Credential :
Telephone Number : 401-770-2937
Provider Enumeration Date : 09/12/2006
Last Update Date : 11/17/2009

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