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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	PH00003410	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3212331	OTHER	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851657464
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 - PHARMACY ENROLLMENTS
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 N RIVERSIDE DR
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2976
Country	:	US
Telephone Number	:	505-367-3594
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-765-1500

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	10/31/2012

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Directions to “CVS PHARMACY INC ” Practice Location

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