MEDICARE: MARYLAND CVS PHARMACY, L.L.C.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	P01637	MD

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2117528	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1306944137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND 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	:	401-765-1500
Fax Number	:	401-770-7108

Provider Business Practice Location Address
First Line	:	7041 MARTIN LTHR KING HWY KINGS SHOP PLZ
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-4016
Country	:	US
Telephone Number	:	301-386-6412
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/09/2021

7021 MARTIN LUTHER KING JR HWY
HYATTSVILLE, MD
20785-4016

Practice Phone: 301-341-4600
Practice Fax:

7041 MARTIN LUTHER KING JR HWY
HYATTSVILLE, MD
20785-4016