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NPI Code Detail

MEDICARE: PENNSYLVANIA CVS PHARMACY LLC

MEDICARE: PENNSYLVANIA 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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPP482364PA
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12138380OTHERPK

General Provider Information

NPI Number : 1932445558
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENNSYLVANIA CVS PHARMACY LLC
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 : 201 S HILLS VLG
Second Line :
City : PITTSBURGH
State : PA
Zip : 15241-1408
Country : US
Telephone Number : 412-595-9381
Fax Number :
Authorized Official
Title or Position : SR. DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 12/31/2012
Last Update Date : 11/30/2016

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