Healthcare Provider Details

I. General information

NPI: 1558532713
Provider Name (Legal Business Name): WEST VIRGINIA CVS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 MIDDLEWAY PIKE
INWOOD WV
25428-3713
US

IV. Provider business mailing address

ONE CVS DRIVE BOX 1075 - PHARMACY ENROLLMENTS
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 304-229-4318
  • 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 StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateWV

VIII. Authorized Official

Name: MRS. SUSAN COLBERT
Title or Position: DIRECTOR
Credential:
Phone: 401-765-1500