MEDICARE: SUPERIOR CARE PHARMACY, 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
1	3336L0003X	Long Term Care Pharmacy	3662251704	UT

General Provider Information

NPI Number	:	1174626964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CARE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	BOX 1075
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 W ALEXANDER ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-2051
Country	:	US
Telephone Number	:	801-266-3999
Fax Number	:	801-685-2264

Authorized Official
Title or Position	:	SR DIRECTOR
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/25/2019

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