MEDICARE: LOUISIANA CVS PHARMACY, 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
2	333600000X	Pharmacy	5405	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1901823	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215031141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA CVS PHARMACY, L.L.C.

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

Provider Business Practice Location Address
First Line	:	3300 YOUREE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2116
Country	:	US
Telephone Number	:	318-869-3453
Fax Number	:	318-869-0784

Authorized Official
Title or Position	:	DIRECTOR,PAYER RELATIIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-7751

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	11/18/2010

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