NPIMap

Holiday CVS LLC

Organization Active NPI Pharmacy · Port Saint Lucie, FL

NPI 1124125612 · NPPES record last updated Jan 17, 2023

Key facts

NPI
1124125612
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
20592 (FL)
Legal business name
HOLIDAY CVS LLC
Practice address
1300 SW St Lucie Blvd
Port Saint Lucie, FL 34986
Phone
(772) 878-7078
Fax
(772) 343-0608
NPI assigned
Sep 19, 2006
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Director
Phone
(401) 765-1500

Corporate family (same tax ID) 24

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.

Medicare participation

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

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081223000620 FL Part B Supplier - Mass Immunization (Roster Biller Only) 2668534702 This NPI is an additional NPI on the enrollment
O20100930037141 FL DME Supplier - Pharmacy 2668534702 Practice locations: Port Saint Lucie, FL

National Provider Directory

Tax ID family
Holiday CVS LLC (738 organizations share this tax ID)

Locations

1300 SW Saint Lucie West Blvd
Port St Lucie, FL 34986
Phone (772) 878-7078

Networks

  • Freedom Health HMO Network
    Plans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO Network
    Plans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 20592 FL Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1300 SW St Lucie Blvd
Port Saint Lucie, FL 34986

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146

Other identifiers

IdentifierTypeStateIssuer
1080439OtherOTHER ID NUMBER-COMMERCIAL NUMBER
106175500MedicaidFL

Other names

  • CVS PHARMACY #05157 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Other providers in Port Saint Lucie, FL

All providers in Port Saint Lucie, FL · Pharmacy in Florida

Sources for this page

Verify at the official NPI Registry.