NPIMap

Louisiana CVS Pharmacy, L.L.C.

Organization Active NPI Pharmacy · Slidell, LA

NPI 1124122056 · NPPES record last updated Feb 29, 2012

Key facts

NPI
1124122056
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
5862 (LA)
Legal business name
LOUISIANA CVS PHARMACY, L.L.C.
Practice address
1305 Gause Blvd
Slidell, LA 70458-3015
Phone
(985) 641-2550
Fax
(985) 641-5765
NPI assigned
Sep 12, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 19

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 20

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #05330
1305 Gause Blvd, Slidell, LA 70458-3015 · (985) 641-2550		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930093109 LA DME Supplier - Pharmacy 7113120312 Practice locations: Slidell, LA
O20101022000661 LA Part B Supplier - Mass Immunization (Roster Biller Only) 7113120312 This NPI is an additional NPI on the enrollment
Practice locations: Marksville, LA; Marrero, LA; Metairie, LA; Morgan City, LA; New Iberia, LA; Opelousas, LA; Plaquemine, LA; Ponchatoula, LA…

National Provider Directory

Tax ID family
CVS Pharmacy LLC (120 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 5862 LA Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1305 Gause Blvd
Slidell, LA 70458-3015

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1901835OtherOTHER ID NUMBER-COMMERCIAL NUMBER
001265721MedicaidLA

Other names

  • CVS PHARMACY #05330 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 29, 2012.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1124122056",
    "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": "1305 GAUSE BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583015",
            "telephone_number": "985-641-2550",
            "fax_number": "985-641-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2012-02-29",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "5862",
            "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": "1901835",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001265721",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #05330",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Slidell, LA

All providers in Slidell, LA · Pharmacy in Louisiana

Sources for this page

Verify at the official NPI Registry.