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NPI Code Detail

MEDICARE: NORTH CAROLINA CVS PHARMACY LLC

MEDICARE: NORTH CAROLINA CVS PHARMACY 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 Pharmacy
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13459408OTHERNCNCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639456502
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH CAROLINA CVS 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 : 7496 ROCKFISH RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28306-8076
Country : US
Telephone Number : 910-424-2905
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 11/07/2011
Last Update Date : 11/13/2012

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