MEDICARE: WARM SPRINGS ROAD CVS LLC

Medicare Provider Information

Scope of Practice

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

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2994223	OTHER	NV	NCPDP

General Provider Information

NPI Number	:	1992166938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARM SPRINGS ROAD 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	:

Provider Business Practice Location Address
First Line	:	3645 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-4321
Country	:	US
Telephone Number	:	702-474-4089
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-1500

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	04/15/2016

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Directions to “WARM SPRINGS ROAD CVS LLC ” Practice Location

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