Active NPI
Pennsylvania CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy #00903
- Pharmacy
- Brookhaven, PA
National Provider Identifier
1013015726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PP413970L
- Legal business name
- PENNSYLVANIA CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy #00903
- Practice address
- 3298 Edgemont Ave
Brookhaven, PA 19015 - Phone
- (610) 876-5100
- NPI assigned
- Sep 20, 2006
- Last updated
- Mar 1, 2012
- 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 Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | PP413970L | PA | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
3298 Edgemont Ave
Brookhaven, PA 19015
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3954410 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #00903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080116000450 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527149566 | This NPI is an additional NPI on the enrollment |
| O20100930006774 | PA | DME Supplier - Pharmacy | 8527149566 | Practice locations: Brookhaven, PA |
National Provider Directory
National Provider Directory- Tax ID family
- Pennsylvania CVS Pharm
Organizations with this tax ID in the same state 20
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba CVS Pharmacy #01575
- Pharmacy
- Northumberland, PA
- NPI 1003910837
-
- Pharmacy
- Kingston, PA
- NPI 1013011865
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1330560000000",
"number": "1013015726",
"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": "3298 EDGEMONT AVE",
"city": "BROOKHAVEN",
"state": "PA",
"postal_code": "19015",
"telephone_number": "610-876-5100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PENNSYLVANIA CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2012-03-01",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "PA",
"license": "PP413970L",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3954410",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #00903",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Brookhaven, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.