MEDICARE: WARM SPRINGS ROAD 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
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	PH01976	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2988749	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1730288044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARM SPRINGS ROAD 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	:	4490 PARADISE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-6573
Country	:	US
Telephone Number	:	702-696-7126
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, MANAGED CARE ADMIN
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/04/2019

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