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NPI Code Detail

MEDICARE: GEORGIA CVS PHARMACY, L.L.C.

MEDICARE: GEORGIA CVS PHARMACY, L.L.C.
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
21158597OTHERGANCPDP

General Provider Information

NPI Number : 1568605400
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA CVS PHARMACY, L.L.C.
Provider Business Mailing Address
First Line : PO BOX A3649
Second Line :
City : CHICAGO
State : IL
Zip : 60690-3649
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 3221 PEACHTREE ROAD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-2414
Country : US
Telephone Number : 404-869-3308
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 04/08/2009
Last Update Date : 03/08/2011

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