Arizona CVS Stores, L.L.C.
Organization Active NPI Pharmacy · Prescott Valley, AZ
NPI 1013142074 · NPPES record last updated Aug 23, 2010
Key facts
- NPI
- 1013142074
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- ARIZONA CVS STORES, L.L.C.
- Practice address
- 3025 N. Windsong Drive
Prescott Valley, AZ 86314 - Phone
- (928) 772-1613
- NPI assigned
- May 20, 2009
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Managed Care Admin
- Phone
- (401) 770-2751
Member of 1
Practitioners 10
-
Austin Freeman, PHARMD
-
Courtney Justine Hammes, PHARMD.
-
Preston Winslow Rhoades, PHARM D
-
Sharon Richardson, RPH
-
Preston Stoddard, PHARMD
-
Christopher Walker, RPH
-
Noe Lugo, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2259817 | Arizona CVS Stores, LLC Dba CVS/Pharmacy | Certificate of waiver | May 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100107000345 | AZ | Part B Supplier - Mass Immunization (Roster Biller Only) | 6406997899 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
3025 N. Windsong Drive
Prescott Valley, AZ 86314
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0356166 | Other | NCPDP | |
| 450326 | Medicaid | AZ |
Other names
- CVS Pharmacy #05983
Other providers in Prescott Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2010. 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.