Oregon CVS Pharmacy LLC
Organization Active NPI Pharmacy · Fairview, OR
NPI 1013939735 · NPPES record last updated Nov 18, 2016
Key facts
- NPI
- 1013939735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- RP-0001960 (OR)
- Legal business name
- OREGON CVS PHARMACY LLC
- Practice address
- 21500 NE Halsey St
Fairview, OR 97024-8616 - Phone
- (503) 491-8953
- Fax
- (503) 491-8953
- NPI assigned
- Jul 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Other NPIs on the same Medicare enrollment 36
Corporate family (same tax ID) 35
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #16745 |
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 OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161103001650 | OR | DME Supplier - Pharmacy | 3476841768 | Practice locations: Fairview, OR |
| O20170104001867 | OR | Part B Supplier - Mass Immunization (Roster Biller Only) | 3476841768 |
40 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portland, OR; Salem, OR; Sherwood, OR; Springfield, OR; Tigard, OR; Wilsonville, OR; Albany, OR; Beaverton, OR… |
National Provider Directory
- Tax ID family
- CVS Pharmacy 11150
Locations
21500 N E Halsey
Fairview, OR 97024
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | RP-0001960 | OR | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
21500 NE Halsey St
Fairview, OR 97024-8616
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2079199 | Other | PK |
Other names
- CVS Pharmacy #16745
Other providers in Fairview, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2016. 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.