Healthcare Provider Details

I. General information

NPI: 1679157614
Provider Name (Legal Business Name): NEW JERSEY CVS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 PARK AVE
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

1 CVS DRIVE BOX 1075
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 908-546-5041
  • Fax: 908-774-4637
Mailing address:
  • Phone: 401-770-1500
  • Fax: 401-770-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SUSAN F COLBERT
Title or Position: SR DIRECTOR
Credential:
Phone: 401-770-2751