MEDICARE: CVS PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	TX
2	3336C0003X	Community/Retail Pharmacy	TX
3	333600000X	Pharmacy	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5922756	OTHER	TX	NCPDP

General Provider Information

NPI Number	:	1205348075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS PHARMACY INC.

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	:

Provider Business Practice Location Address
First Line	:	3200 N BIG SPRING ST
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5315
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-765-1500

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	01/02/2018

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