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NPI Code Detail

MEDICARE: WOODWARD DETROIT CVS, L.L.C.

MEDICARE: WOODWARD DETROIT CVS, 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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy5301-007114MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12360585OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1720187024
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODWARD DETROIT CVS, L.L.C.
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : PO BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 39350 9 MILE RD
Second Line :
City : NORTHVILLE
State : MI
Zip : 48167-9164
Country : US
Telephone Number : 248-735-6081
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-765-1500
Provider Enumeration Date : 09/22/2006
Last Update Date : 02/29/2012

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