Active NPI
CVS Pharmacy Inc
Doing business as CVS Pharmacy #17318
- Pharmacy
- Grand Prairie, TX
National Provider Identifier
1053461301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- CVS PHARMACY INC
- Doing business as
- CVS Pharmacy #17318
- Practice address
- 5270 S State Highway 360
Grand Prairie, TX 75052-8307 - Phone
- (469) 348-2101
- NPI assigned
- Jan 11, 2007
- Last updated
- Jun 12, 2024
- 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
- Sr. Director, Payer Relations
- Phone
- (800) 746-7287
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | Primary | |
| Community/Retail Pharmacy | 3336C0003X | 30511 | TX |
Addresses
Primary practice location
5270 S State Highway 360
Grand Prairie, TX 75052-8307
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2099924 | Other | PK |
Other names 1
- CVS Pharmacy #17318
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 |
| O20161207000216 | TX | DME Supplier - Pharmacy | 5092711895 | Practice locations: Grand Prairie, 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 #17318 | 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 Agent for CVS RX Services 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718150400000",
"number": "1053461301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "401-735-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5270 S STATE HIGHWAY 360",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750528307",
"telephone_number": "469-348-2101"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CVS PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-11",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "800-746-7287"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "30511",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2099924",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #17318",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Grand Prairie, TX
- Doris Cudjoe, PMHNP -BC
- David Cudlipp, (P.T)
- Yesenia Cuellar, OTR
- Frank Peter Cundari, D.O.
- Kierstin Elizabeth Curtis, CCC-SLP
- CVS Pharmacy Inc (CVS Pharmacy #07421)
- CVS Pharmacy Inc (CVS Pharmacy # 06775)
- CVS Pharmacy Inc (CVS Pharmacy#07809)
- CVS Pharmacy, Inc. (CVS Pharmacy #08345)
- D&D Residential Services Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.