MEDICARE: NORTH CAROLINA 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 State
1	332B00000X	Durable Medical Equipment & Medical Supplies	NC
2	3336C0003X	Community/Retail Pharmacy	NC
3	333600000X	Pharmacy	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3466403	OTHER	NC	NCPDP

General Provider Information

NPI Number	:	1720436439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CAROLINA CVS PHARMACY, L.L.C.

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4908 HOUSTON FIELD COURT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277
Country	:	US
Telephone Number	:	704-814-0212
Fax Number	:

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

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	12/06/2016

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