MEDICARE: NEBRASKA CVS PHARMACY LLC

Medicare Provider Information

Scope of Practice

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

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2818966	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366821944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBRASKA CVS PHARMACY LLC

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

Provider Business Practice Location Address
First Line	:	2307 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-3303
Country	:	US
Telephone Number	:	402-564-5105
Fax Number	:

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	10/07/2015

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