MEDICARE: KANSAS CVS PHARMACY, L.L.C.

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	2-09932	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1717909	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972607828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS CVS PHARMACY, L.L.C.

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	:	1785 S MUR LEN RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-2611
Country	:	US
Telephone Number	:	913-390-9892
Fax Number	:	913-390-9523

Authorized Official
Title or Position	:	MGR PHCY ENROLLMENTS
Name	:	CRISTIANA MAURICIO
Credential	:
Telephone Number	:	401-770-2937

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	09/30/2014

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