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NPI Code Detail

MEDICARE: WOODWARD DETROIT CVS, LLC

MEDICARE: WOODWARD DETROIT 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22377112OTHERMINCPDP

General Provider Information

NPI Number : 1750639415
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODWARD DETROIT CVS, LLC
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 : 401-770-7108
Provider Business Practice Location Address
First Line : 2010 E APPLE AVE
Second Line :
City : MUSKEGON
State : MI
Zip : 49442-4348
Country : US
Telephone Number : 231-767-1122
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-765-1500
Provider Enumeration Date : 08/28/2012
Last Update Date : 04/20/2020

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