NPIMap

Organization Active NPI

Georgia CVS Pharmacy LLC

  • Pharmacy
  • Lagrange, GA
National Provider Identifier
1083717847
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
007847 Issued in GA
Legal business name
GEORGIA CVS PHARMACY LLC
Practice address
300 Morgan Street
Lagrange, GA 30241-3229
Phone
(706) 882-2971
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Susan Colbert
Title
Director, Payer Relations
Phone
(401) 770-2751

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20100209000543 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8123161429 This NPI is an additional NPI on the enrollment
O20110427000483 GA DME Supplier - Pharmacy 8123161429 Practice locations: Lagrange, GA

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 06861 (290 organizations share this tax ID)

Locations

300 N Morgan St
Lagrange, GA 30240
Phone (706) 882-2971

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X GA
Pharmacy 333600000X 007847 GA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

NPPES NPI Registry

Primary practice location

300 Morgan Street
Lagrange, GA 30241-3229

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1141477OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

NPPES NPI Registry
  • CVS PHARMACY 07615 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 21, 2015.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1083717847",
    "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",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MORGAN STREET",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413229",
            "telephone_number": "706-882-2971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "007847",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1141477",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY 07615",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.