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NPI Code Detail

MEDICARE: GEORGIA CVS PHARMACY, L.L.C.

MEDICARE: GEORGIA 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 License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesGA
23336C0003XCommunity/Retail PharmacyGA
3333600000XPharmacyGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11159044OTHERGANCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730312190
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA CVS PHARMACY, 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 : 401-770-7108
Provider Business Practice Location Address
First Line : 687 JOHNSON FERRY RD
Second Line :
City : MARIETTA
State : GA
Zip : 30068-4628
Country : US
Telephone Number : 770-977-9220
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/01/2009
Last Update Date : 03/08/2011

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