MEDICARE: PENNSYLVANIA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16092126382	OTHER	PA	PACE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3998018	OTHER	PA	NCPDP

General Provider Information

NPI Number	:	1609126382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSYLVANIA CVS PHARMACY LLC

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	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	:	2132 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1227
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR,PAYER RELATIONS
Name	:	SUSAN F. COLBERT
Credential	:
Telephone Number	:	401-765-1500

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	05/31/2013

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