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Provider Information for 1710386206


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VIRGINIA CVS PHARMACY LLC

Other Names:  
Doing Business As: 
CVS PHARMACY # 02776

Organization Subpart: NO

NPI: 1710386206
Last Updated: 2015-01-09
Certification Date:

Details

NameValue
NPI1710386206
Enumeration Date2014-08-20
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SUSAN F COLBERT
Title: Director, Payer Relations
Phone: 4017702751
Mailing Address 1 CVS DR
BOX 1075 - PHARMACY ENROLLMENT
WOONSOCKET, RI 02895-6146
United States

Phone: 401-765-1500 | Fax:401-770-7108
 
Primary Practice Address 1280 N GREAT NECK RD
VIRGINIA BEACH, VA 23454-2126
United States

Phone: 757-481-2678 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDVA1710386206
Other (non-Medicare)VA4845698NCPDP
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy