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NPI Code Detail

MEDICARE: PENNSYLVANIA CVS PHARMACY, L.L.C.

MEDICARE: PENNSYLVANIA CVS PHARMACY, L.L.C.
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
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacyPP413104LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13912549OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1902909757
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENNSYLVANIA CVS PHARMACY, L.L.C.
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 : 330 W COLUMBUS AVE
Second Line :
City : CORRY
State : PA
Zip : 16407-1002
Country : US
Telephone Number : 814-664-2617
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-765-1500
Provider Enumeration Date : 09/07/2006
Last Update Date : 09/15/2014

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