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Provider Information for 1477741221


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CVS PHARMACY INC

Other Names:  
Doing Business As: 
CVS PHARMACY #08319

Organization Subpart: NO

NPI: 1477741221
Last Updated: 2011-10-12
Certification Date:

Details

NameValue
NPI1477741221
Enumeration Date2007-10-05
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SUSAN F COLBERT
Title: Director, Payer Relations
Phone: 4017702751
Mailing Address ONE CVS DRIVE
BOX 1075 - PHARMACY ENROLLMENTS
WOONSOCKET, RI 02895
United States

Phone: 401-765-1500 | Fax:
 
Primary Practice Address 1 DAVIS SQ
SOMERVILLE, MA 02144-2904
United States

Phone: 617-629-4156 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMA0415600
Other (non-Medicare)2242092NCPDP - OTHER COMMERCIAL IDENTIFIER
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies MA
No 3336C0003X - Pharmacy - Community/Retail PharmacyMA
Yes 333600000X - Pharmacy MA