Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy# 04362
- Pharmacy
- Wesley Chapel, FL
National Provider Identifier
1104070101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy# 04362
- Practice address
- 30050 County Line Rd
Wesley Chapel, FL 33543 - Phone
- (813) 907-1423
- NPI assigned
- Nov 5, 2008
- Last updated
- Mar 11, 2010
- 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 Pharmacy Enrollments
- Phone
- (401) 765-2751
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
30050 County Line Rd
Wesley Chapel, FL 33543
Mailing address
1 CVS Dr
Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS PHARMACY# 04362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20100930062318 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Wesley Chapel, FL |
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 |
|---|---|---|---|
| 10D2227484 | Holiday CVS, LLC Dba CVS/Pharmacy #4362 | Certificate of waiver | Jun 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #04362 | 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… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Holiday 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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
30050 County Line Rd
Wesley Chapel, FL 33543
Phone (813) 907-1423
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
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
- Wesley Chapel, FL
- NPI 1457175200
-
- Pharmacist
- Wesley Chapel, FL
- NPI 1295224749
-
- Pharmacist
- Wesley Chapel, FL
- NPI 1205439577
-
- Pharmacist
- Wesley Chapel, FL
- NPI 1669077285
-
- Pharmacist
- Wesley Chapel, FL
- NPI 1336962448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1268265600000",
"number": "1104070101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075-PHARMACY 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": "30050 COUNTY LINE RD",
"city": "WESLEY CHAPEL",
"state": "FL",
"postal_code": "33543",
"telephone_number": "813-907-1423"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-05",
"last_updated": "2010-03-11",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "DIRECTOR PHARMACY ENROLLMENTS",
"authorized_official_telephone_number": "401-765-2751"
},
"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": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY# 04362",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wesley Chapel, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.