Woodward Detroit CVS, L.L.C.
Organization Active NPI Pharmacy · Kimball, MI
NPI 1013029958 · NPPES record last updated Apr 4, 2017
Key facts
- NPI
- 1013029958
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 5301-005098 (MI)
- Legal business name
- WOODWARD DETROIT CVS, L.L.C.
- Practice address
- 4514 Gratiot Rd
Kimball, MI 48074-4508 - Phone
- (810) 364-6980
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director
- Phone
- (401) 765-1500
Corporate family (same tax ID) 14
Member of 1
Practitioners 5
-
Martha Ann Fisher, RPH
-
Nicholas Scott Kreitzbender, PHARM.D.
-
Lena Matti, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2255728 | Woodward Detroit CVS, LLC Dba CVS/Pharmacy #08053 | Certificate of waiver | Mar 16, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #08053 |
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… | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930048861 | MI | DME Supplier - Pharmacy | 4688875149 | Practice locations: Kimball, MI |
| O20110208000865 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688875149 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Woodward Detroit CVS LLC
Locations
4514 Gratiot Rd
Kimball, MI 48074
Phone (810) 364-6980
3210 Gratiot Blvd
Marysville, MI 48040
Phone (810) 364-6980
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 5301-005098 | MI | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4514 Gratiot Rd
Kimball, MI 48074-4508
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1911886 | Medicaid | MI | |
| 2343666 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY #08053
Other providers in Kimball, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.