Active NPI
Pennsylvania CVS Pharmacy LLC
Doing business as CVS Pharmacy # 01805
- Pharmacy
- Coatesville, PA
National Provider Identifier
1063709442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- PENNSYLVANIA CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy # 01805
- Practice address
- 101 Reecesville Rd.
Coatesville, PA 19320 - Phone
- (610) 466-7166
- NPI assigned
- Jul 6, 2011
- Last updated
- Feb 22, 2012
- 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 F Colbert
- Title
- 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 |
Addresses
Primary practice location
101 Reecesville Rd.
Coatesville, PA 19320
Mailing address
1 CVS Dr
P.O. Box 1075-Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1015538870396 | Medicaid | PA | |
| 1063709442 | Other | PA | PACE |
| 3995682 | Other | PA | NCPDP |
Other names 1
- CVS Pharmacy # 01805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080116000450 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527149566 | This NPI is an additional NPI on the enrollment |
| O20111209000658 | PA | DME Supplier - Pharmacy | 8527149566 | Practice locations: Coatesville, PA |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2282291 | CVS/Pharmacy #01805 | Certificate of waiver | May 18, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Pennsylavanis CVS Pharm
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
101 Reeceville Rd
Coatesville, PA 19320
Phone (610) 466-7166
Practitioners & affiliated clinicians
Practitioners 5
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
- Coatesville, PA
- NPI 1114518164
-
- Pharmacist
- Coatesville, PA
- NPI 1053908418
-
- Pharmacist
- Coatesville, PA
- NPI 1487455093
-
- Pharmacist
- Coatesville, PA
- NPI 1962007138
-
- Pharmacist
- Coatesville, PA
- NPI 1144144668
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1329868800000",
"number": "1063709442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "P.O. BOX 1075-ENROLLMENTS",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 REECESVILLE RD.",
"city": "COATESVILLE",
"state": "PA",
"postal_code": "19320",
"telephone_number": "610-466-7166"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PENNSYLVANIA CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-07-06",
"last_updated": "2012-02-22",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "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": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1015538870396",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACE",
"identifier": "1063709442",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "3995682",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy # 01805",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Coatesville, PA
- Pearls Academy
- Mary Pearson
- Xurui Peng, DMD
- Penna Association for the Blind Chester County Branch Inc (CCABVI Chester County Association for the Blind and Visually Impaired)
- Pennsylvania Clinical Schools, Inc
- Davy Peou, PHARMD
- Neeraja Peri, M.D.
- Theresa M Perri, PA-C
- Dora R. Perry, PA-C
- Jeremy Peterson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.