MEDICARE: HOLIDAY CVS 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 Issuer
1	032602802	OTHER	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1033012	OTHER	NCPDP

General Provider Information

NPI Number	:	1417127648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIDAY CVS LLC

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	BOX 1075-PHARMACY ENROLLMENTS
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	:	6206 COMMERCE PALMS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1506
Country	:	US
Telephone Number	:	813-971-2459
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PHARMACY ENROLLMENTS
Name	:	SUSAN F COLBERT
Credential	:
Telephone Number	:	401-765-2751

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/18/2022

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