New Jersey CVS Pharmacy LLC
Organization Active NPI Pharmacy · Lawrenceville, NJ
NPI 1063504652 · NPPES record last updated Nov 3, 2010
Key facts
- NPI
- 1063504652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 5728 (NJ)
- Legal business name
- NEW JERSEY CVS PHARMACY LLC
- Practice address
- 1900 US Highway 1
Lawrenceville, NJ 08648-4604 - Phone
- (609) 392-6476
- NPI assigned
- Sep 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director
- Phone
- (401) 765-1500
Corporate family (same tax ID) 24
Member of 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100830000881 | NJ | Part B Supplier - Mass Immunization (Roster Biller Only) | 2365566288 | This NPI is an additional NPI on the enrollment |
| O20100930029174 | NJ | DME Supplier - Pharmacy | 3678777851 | Practice locations: Lawrenceville, NJ |
National Provider Directory
- Tax ID family
- New Jersey CVS Pharmacy LLC
Locations
1900 US Highway 1
Lawrenceville, NJ 08648
Phone (609) 392-6476
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 5728 | NJ | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1900 US Highway 1
Lawrenceville, NJ 08648-4604
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3141164 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY 02126
Other providers in Lawrenceville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.