MEDICARE: OREGON 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

General Provider Information

NPI Number	:	1558954354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON CVS PHARMACY LLC

Provider Business Mailing Address
First Line	:	1 CVS DR # 1075
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	:	640 SW BROADWAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-3401
Country	:	US
Telephone Number	:	503-535-6032
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR, PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	03/03/2021

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Directions to “OREGON CVS PHARMACY LLC ” Practice Location

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