MEDICARE: LOUISIANA 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1938919	OTHER		NCPDP

General Provider Information

NPI Number	:	1629447594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA CVS PHARMACY LLC

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	BOX 1075 PHARMACY ENROLLMENTS
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 LOUISIANA AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2454
Country	:	US
Telephone Number	:	504-891-1818
Fax Number	:

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

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	12/11/2015

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