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NPI Code Detail

MEDICARE: OHIO CVS STORES LLC

MEDICARE: OHIO CVS STORES 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
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy02-486500OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13640136OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1821191586
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO CVS STORES 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 :
Fax Number :
Provider Business Practice Location Address
First Line : 9546 MONTGOMERY RD
Second Line :
City : MONTGOMERY
State : OH
Zip : 45242-7220
Country : US
Telephone Number : 513-793-4451
Fax Number :
Authorized Official
Title or Position : DIRECTOR, MANAGED CARE ADMIN
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 09/07/2006
Last Update Date : 12/02/2010

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Directions to “OHIO CVS STORES LLC ” Practice Location

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