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Provider Information for 1215031158


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GEORGIA CVS PHARMACY, L.L.C.

Other Names:  
Doing Business As: 
CVS PHARMACY #03125

Organization Subpart: NO

NPI: 1215031158
Last Updated: 2012-03-06
Certification Date:

Details

NameValue
NPI1215031158
Enumeration Date2006-09-12
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SUSAN F COLBERT
Title: Director, Payer Relations
Phone: 4017702751
Mailing Address 1 CVS DR
PO BOX 1075
WOONSOCKET, RI 02895-6146
United States

Phone: | Fax:
 
Primary Practice Address 895 HOLCOMB BRIDGE RD
ROSWELL, GA 30076-1954
United States

Phone: 770-993-0194 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1150387Other ID Number-Commercial Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy GA8681
No 332B00000X - Durable Medical Equipment & Medical Supplies