MEDICARE: HOLIDAY CVS, L.L.C.

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	5703029	OTHER		NCPDP

General Provider Information

NPI Number	:	1659673713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIDAY CVS, L.L.C.

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	:	401-765-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	49581 US HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33897-9507
Country	:	US
Telephone Number	:	863-420-7563
Fax Number	:

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	12/04/2012

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