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General NPI Number Information
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NPI Number | 1194020602
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Entity Type | Organization
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Legal Business Name | IOWA CVS PHARMACY, LLC
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 545 W. WASHINGTON ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0771
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Country | US
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Telephone | 712-352-4152
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CVS DR BOX - 1075 PHCY ENROLLMENTS
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City | WOONSOCKET
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State | RI
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Zip | 02895-6146
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Country | US
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Telephone | 401-765-1500
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Fax | 401-770-7108
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Authorized Official
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Title or Position | DIRECTOR, PAYER RELATIONS
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Name | SUSAN F COLBERT
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Credential |
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Telephone | 401-770-2751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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