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NPI Code Detail

MEDICARE: WOODWARD DETROIT CVS LLC

MEDICARE: WOODWARD DETROIT CVS LLC
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
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22385880OTHERMINCPDP

General Provider Information

NPI Number : 1134691041
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODWARD DETROIT CVS LLC
Provider Business Mailing Address
First Line : 1 CVS DR # 1075
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number : 401-770-7108
Provider Business Practice Location Address
First Line : 10 COLUMBIA AVE E
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49015-3704
Country : US
Telephone Number : 269-962-1965
Fax Number :
Authorized Official
Title or Position : SR. DR, PAYER RELATIONS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 12/18/2018
Last Update Date : 06/18/2019

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