MEDICARE: WOODWARD DETROIT CVS, L.L.C.

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	3336C0003X	Community/Retail Pharmacy	5301007855	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2336887	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184732547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODWARD DETROIT CVS, L.L.C.

Provider Business Mailing Address
First Line	:	1 CVS DRIVE
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	:	225 E STATE ST
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9004
Country	:	US
Telephone Number	:	810-639-0049
Fax Number	:	810-639-6179

Authorized Official
Title or Position	:	SR. DIRECTOR, PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	02/01/2021

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