MEDICARE: CVS PHARMACY INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	1003	MA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2225058	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1538268990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS PHARMACY INC

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	:	2235 DORCHESTER AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02124-5623
Country	:	US
Telephone Number	:	617-296-1025
Fax Number	:

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/15/2013

75 FRANCIS STREET , BRIGHAM INTERNAL MEDICARE ASSOCIATES
BOSTON, MA
02115

Practice Phone: 617-732-6049
Practice Fax: 617-264-5202