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Provider Information for 1811090558


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OHIO CVS STORES LLC

Other Names:  
Doing Business As: 
CVS PHARMACY 04316

Organization Subpart: NO

NPI: 1811090558
Last Updated: 2011-08-05
Certification Date:

Details

NameValue
NPI1811090558
Enumeration Date2006-09-07
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SUSAN COLBERT
Title: Director
Phone: 4017651500
Mailing Address 1 CVS DR
PO BOX 1075
WOONSOCKET, RI 02895-6146
United States

Phone: | Fax:
 
Primary Practice Address 6301 HARVARD AVE
CLEVELAND, OH 44105-4862
United States

Phone: 216-271-0970 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)3627570Other ID Number-Commercial Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy OH21-39150