NPIMap

Organization Active NPI

Garfield Beach CVS LLC

  • Pharmacy
  • Huntington Park, CA
National Provider Identifier
1104337898
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
GARFIELD BEACH CVS LLC
Practice address
3208 E Florence Ave
Huntington Park, CA 90255-5832
Phone
(323) 589-1916
NPI assigned
Oct 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Authorized official

Name
Susan F Colbert
Title
Sr Director Payer Relations
Phone
(401) 765-1500

Specialties & licenses 3

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

Addresses

Primary practice location

3208 E Florence Ave
Huntington Park, CA 90255-5832

Mailing address

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

Other names 1

  • CVS Pharmacy #11073 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080117000218 CA Part B Supplier - Mass Immunization (Roster Biller Only) 5799866620 This NPI is an additional NPI on the enrollment
O20180219002532 CA DME Supplier - Pharmacy 5799866620 Practice locations: Huntington Park, CA

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2229956Garfield Beach CVS, LLC3208 East Florence Ave, Huntington Park, CA 90255Certificate of waiverJul 18, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #110733208 E Florence Ave, Huntington Park, CA 90255-5832(323) 589-1916 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
CVS Pharmacy 09583721 organizations share this tax ID, including this one

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.

View all 24

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1508457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1104337898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DRIVE",
            "address_2": "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": "3208 E FLORENCE AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902555832",
            "telephone_number": "323-589-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARFIELD BEACH CVS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-20",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR DIRECTOR PAYER RELATIONS",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "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 #11073",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS Pharmacy #11073",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.