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NPI Code Detail

MEDICARE: HOLIDAY CVS LLC

MEDICARE: HOLIDAY CVS LLC
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
2333600000XPharmacy20196FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21082077OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1740384619
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOLIDAY CVS LLC
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 : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 4280 SOUTHSIDE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5400
Country : US
Telephone Number : 904-998-3677
Fax Number : 904-998-1553
Authorized Official
Title or Position : DIRECTOR PHCY ENROLLMENTS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/12/2006
Last Update Date : 09/26/2011

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