NPIMap

Organization Active NPI

Mississippi CVS Pharmacy, L.L.C.

Doing business as CVS Pharmacy #05604

  • Pharmacy
  • Olive Branch, MS
National Provider Identifier
1093046500
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MISSISSIPPI CVS PHARMACY, L.L.C.
Doing business as
CVS Pharmacy #05604
Practice address
5025 Highway 305 N
Olive Branch, MS 38654-3602
Phone
(662) 890-3548
NPI assigned
Jan 22, 2010
Last updated
Mar 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

5025 Highway 305 N
Olive Branch, MS 38654-3602

Mailing address

One CVS Drive
Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895
Phone (401) 765-1500

Other identifiers 3

IdentifierTypeStateIssuer
07158876OtherMSMEDICAID DME
2587915OtherNCPDP
03337761MedicaidMS

Other names 1

  • CVS Pharmacy #05604 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930022437 MS DME Supplier - Pharmacy 9335344456 Practice locations: Olive Branch, MS
O20101230001038 MS Part B Supplier - Mass Immunization (Roster Biller Only) 9335344456 This NPI is an additional NPI on the enrollment
Practice locations: Picayune, MS; Pascagoula, MS; Oxford, MS; Olive Branch, MS; Ocean Springs, MS; Natchez, MS; Laurel, MS; Meridian, MS…

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
CVS Pharmacy #056045025 Highway 305 N, Olive Branch, MS 38654-3602(662) 890-3548 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 assignmentParticipating since Jan 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Mississippi CVS Pharmacy LLC48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Member of 1

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

Locations

5025 Highway 305 N
Olive Branch, MS 38654
Phone (662) 890-3548

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1093046500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CVS DRIVE",
            "address_2": "BOX 1075-PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "02895",
            "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": "5025 HIGHWAY 305 N",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543602",
            "telephone_number": "662-890-3548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2012-03-01",
        "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": "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": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "07158876",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2587915",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03337761",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #05604",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.

Verify at the official NPI Registry.