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NPI Code Detail

MEDICARE: WISCONSIN CVS PHARMACY LLC

MEDICARE: WISCONSIN CVS PHARMACY 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 Pharmacy8058042WI
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12109849OTHERPK

General Provider Information

NPI Number : 1932121530
Entity Type Code : Organization
Provider Name (Legal Business Name) : WISCONSIN CVS PHARMACY LLC
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : MAIL CODE 1090
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 1001 CORMIER RD
Second Line :
City : ASHWAUBENON
State : WI
Zip : 54304-4404
Country : US
Telephone Number : 920-499-2608
Fax Number : 920-499-2608
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 : 12/13/2016

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