Healthcare Provider Details

I. General information

NPI: 1912156910
Provider Name (Legal Business Name): CVS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WASHINGTON ST
TAUNTON MA
02780-3918
US

IV. Provider business mailing address

1 CVS DR BOX 1075 - PHARMACY ENROLLMENTS
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 508-821-5605
  • Fax:
Mailing address:
  • Phone: 401-765-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0416550
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier2242523
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER COMMERCIAL IDENTIFIER - NCPDP

VIII. Authorized Official

Name: SUSAN F COLBERT
Title or Position: DIRECTOR, PAYER RELATIONS
Credential:
Phone: 401-770-2751