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NPI Code Detail

MEDICARE: CVS PHARMACY INC.

MEDICARE: CVS PHARMACY INC.
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 Pharmacy30472TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12095547OTHERPK

General Provider Information

NPI Number : 1790707453
Entity Type Code : Organization
Provider Name (Legal Business Name) : CVS PHARMACY INC.
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : 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 : 6419 SKILLMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75231-7109
Country : US
Telephone Number : 214-343-7418
Fax Number : 214-414-9235
Authorized Official
Title or Position : SR. DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 07/24/2006
Last Update Date : 08/25/2016

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