Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy 03631
- Pharmacy
- Ponte Vedra, FL
National Provider Identifier
1003910910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 20314
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy 03631
- Practice address
- 152 Front St
Ponte Vedra, FL 32082-3058 - Phone
- (904) 285-3634
- Fax
- (904) 285-7378
- NPI assigned
- Sep 12, 2006
- Last updated
- Dec 17, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan F Colbert
- Title
- Director Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 20314 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
152 Front St
Ponte Vedra, FL 32082-3058
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1048481 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 105583600 | Medicaid | FL |
Other names 1
- CVS PHARMACY 03631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20100930017582 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Ponte Vedra, FL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Holiday CVS LLC | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Holiday CVS LLC
Organizations with this tax ID in the same state 15
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
152 Front St
Ponte Vedra Beach, FL 32082
Phone (904) 285-3634
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1387238400000",
"number": "1003910910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "152 FRONT ST",
"city": "PONTE VEDRA",
"state": "FL",
"postal_code": "320823058",
"telephone_number": "904-285-3634",
"fax_number": "904-285-7378"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2013-12-17",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "DIRECTOR PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "20314",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1048481",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "105583600",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 03631",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ponte Vedra, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.