CVS Pharmacy Inc
Organization Active NPI Pharmacy · La Marque, TX
NPI 1104204577 · NPPES record last updated Oct 22, 2015
Key facts
- NPI
- 1104204577
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- CVS PHARMACY INC
- Practice address
- 204 Newman Rd
La Marque, TX 77568-3439 - Phone
- (409) 938-1149
- NPI assigned
- May 18, 2015
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Practitioners 3
-
Jonika Lyne Hamilton-Mathews, PHARM D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2256535 | CVS Pharmacy, Inc Dba CVS/Pharmacy #10598 | Certificate of waiver | Mar 23, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #10598 |
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 assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090408000170 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092711895 | This NPI is an additional NPI on the enrollment |
| O20150827000707 | TX | DME Supplier - Pharmacy | 5092711895 | Practice locations: La Marque, TX |
National Provider Directory
- Tax ID family
- CVS Pharmacy Inc Agent for CVS RX Services Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
204 Newman Rd
La Marque, TX 77568-3439
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5915561 | Other | NCPDP | |
| 467173 | Medicaid | TX |
Other names
- CVS Pharmacy #10598
Other providers in La Marque, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.