MEDICARE: GARFIELD BEACH CVS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NCPCP	OTHER		5664025

General Provider Information

NPI Number	:	1902329246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARFIELD BEACH 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	:	15180 KENSINGTON PARK DR
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-1801
Country	:	US
Telephone Number	:	714-259-7625
Fax Number	:	714-259-4849

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	03/21/2018

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