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NPI Code Detail

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

MEDICARE: GEORGIA 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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical SuppliesGA
3333600000XPharmacy008015GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11142900OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356445274
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA 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 :
Provider Business Practice Location Address
First Line : 3051 SANDY PLAINS RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-4721
Country : US
Telephone Number : 770-977-7661
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/12/2006
Last Update Date : 03/05/2012

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