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NPI Code Detail

MEDICARE: GEORGIA CVS PHARMACY LLC

MEDICARE: GEORGIA 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
1332B00000XDurable Medical Equipment & Medical SuppliesGA
23336C0003XCommunity/Retail PharmacyGA
3333600000XPharmacyGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21163017OTHERGANCPDP

General Provider Information

NPI Number : 1528302403
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA CVS PHARMACY LLC
Provider Business Mailing Address
First Line : ONE CVS DRIVE
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 1520 AVENUE PL
Second Line : SUITE B-100
City : ATLANTA
State : GA
Zip : 30329-4015
Country : US
Telephone Number : 404-639-5575
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 11/16/2012
Last Update Date : 03/18/2014

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Directions to “GEORGIA CVS PHARMACY LLC ” Practice Location

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