MEDICARE: RHODE ISLAND 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		RI
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	00057	RI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3910048	OTHER	RI	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4102896	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1508960303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHODE ISLAND 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	:	120 EDDIE DOWLING HWY
Second Line	:
City	:	N. SMITHFIELD
State	:	RI
Zip	:	02896-8214
Country	:	US
Telephone Number	:	401-762-3172
Fax Number	:

Authorized Official
Title or Position	:	MGR PHCY ENROLLMENTS
Name	:	CRISTIANA MAURICIO
Credential	:
Telephone Number	:	401-770-2937

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/27/2014

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: