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NPI Code Detail

MEDICARE: NORTH CAROLINA CVS PHARMACY LLC

MEDICARE: NORTH CAROLINA CVS PHARMACY LLC
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 Supplies
3333600000XPharmacy8051NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13439569OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1528162294
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH CAROLINA CVS PHARMACY LLC
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 : 1142 N BROOME ST
Second Line :
City : WAXHAW
State : NC
Zip : 28173-9378
Country : US
Telephone Number : 704-843-4680
Fax Number :
Authorized Official
Title or Position : DIRECTOR, MANAGED CARE ADMIN
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/12/2006
Last Update Date : 07/09/2013

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