Active NPI
Woodward Detroit CVS, L.L.C.
Doing business as CVS Pharmacy #08103
- Pharmacy
- Hazel Park, MI
National Provider Identifier
1073625919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5301-005452
- Legal business name
- WOODWARD DETROIT CVS, L.L.C.
- Doing business as
- CVS Pharmacy #08103
- Practice address
- 33 West Nine Mile Rd.
Hazel Park, MI 48030-1413 - Phone
- (248) 541-1650
- Fax
- (248) 414-5753
- NPI assigned
- Aug 31, 2006
- Last updated
- Jun 26, 2014
- 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
- Director
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | 5301-005452 | MI | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
33 West Nine Mile Rd.
Hazel Park, MI 48030-1413
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2347486 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 2683275 | Medicaid | MI |
Other names 1
- CVS PHARMACY #08103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930019150 | MI | DME Supplier - Pharmacy | 4688875149 | Practice locations: Hazel Park, MI |
| O20110208000865 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688875149 | This NPI is an additional NPI on the enrollment |
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 |
|---|---|---|---|
| 23D2071768 | Woodward Detroit CVS, LLC | Certificate of waiver | Jan 16, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #08103 | Immunosuppressive 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|Urological Supplies|Ent… | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Woodward Detroit CVS LLC
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.
-
dba CVS Pharmacy # 10592
- Community/Retail Pharmacy
- Saint Joseph, MI
- NPI 1093181943
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1403740800000",
"number": "1073625919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 WEST NINE MILE RD.",
"city": "HAZEL PARK",
"state": "MI",
"postal_code": "480301413",
"telephone_number": "248-541-1650",
"fax_number": "248-414-5753"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WOODWARD DETROIT CVS, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2014-06-26",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MI",
"license": "5301-005452",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "2347486",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2683275",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #08103",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hazel Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.