Active NPI
CVS Pharmacy Inc
Doing business as CVS Pharmacy # 11152
- Pharmacy
- Clarksville, TX
National Provider Identifier
1043395270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- CVS PHARMACY INC
- Doing business as
- CVS Pharmacy # 11152
- Practice address
- 1909 W Broadway St
Clarksville, TX 75426-2010 - Phone
- (903) 427-2050
- Fax
- (903) 885-1024
- NPI assigned
- Oct 26, 2006
- 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
- Senior Director
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X | 25875 | TX |
Addresses
Primary practice location
1909 W Broadway St
Clarksville, TX 75426-2010
Mailing address
1 CVS Dr
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2097344 | Other | PK | |
| 471147 | Medicaid | TX |
Other names 1
- CVS PHARMACY # 11152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090408000170 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092711895 | This NPI is an additional NPI on the enrollment |
| O20161121002233 | TX | DME Supplier - Pharmacy | 5092711895 | Practice locations: Clarksville, TX |
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 |
|---|---|---|
| CVS Pharmacy #11152 | 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
- CVS Pharmacy Inc
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
1909 W Broadway St
Clarksville, TX 75426
Phone (903) 427-2050
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Clarksville, TX
- NPI 1467761536
-
- Pharmacist
- Clarksville, TX
- NPI 1023248051
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1481760000000",
"number": "1043395270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"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": "1909 W BROADWAY ST",
"city": "CLARKSVILLE",
"state": "TX",
"postal_code": "754262010",
"telephone_number": "903-427-2050",
"fax_number": "903-885-1024"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CVS PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-26",
"last_updated": "2016-12-15",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SENIOR DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "25875",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2097344",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "471147",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY # 11152",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clarksville, TX
- Clarksville Nursing Center, L.P. (Clarksville Nursing Center)
- Clarksville Pharmacy LLC (Clarksville Pharmacy)
- Bobby S. Conway, M.S. LPC
- Core Health Systems
- Country Home Care, Inc. (Country Home Care)
- Daily Medical Supply, Inc. (Home Oxygen & Medical Equipment)
- Detroit I.S.D.
- East Texas Medical Center Clarksville (ETMC First Physicians Clinic Clarksville)
- East Texas Medical Center Clarksville (ETMC First Physicians Clinic Clarksville)
- East Texas Medical Center Clarksville
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; 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.