MEDICARE: HOLIDAY CVS, L.L.C.

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	001842001	OTHER	FL	DME
2	1051452	OTHER		NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447589940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIDAY CVS, L.L.C.

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	:	6790 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6025
Country	:	US
Telephone Number	:	407-238-4726
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, PAYER RELATIONS
Name	:	SUE COLBERT
Credential	:
Telephone Number	:	401-765-1500

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	10/25/2010

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Directions to “HOLIDAY CVS, L.L.C. ” Practice Location

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