Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy #05157
- Pharmacy
- Port Saint Lucie, FL
National Provider Identifier
1124125612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 20592
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy #05157
- 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
- Last updated
- Jan 17, 2023
- 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 Colbert
- Title
- Director
- Phone
- (401) 765-1500
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 20592 | FL | Primary |
| 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 names 1
- CVS PHARMACY #05157
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
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 |
| O20100930037141 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Port Saint Lucie, FL |
National Provider Directory
National Provider Directory- Tax ID family
- Holiday CVS
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
1300 SW Saint Lucie West Blvd
Port St Lucie, FL 34986
Phone (772) 878-7078
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158624000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1673913600000",
"number": "1124125612",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 SW ST LUCIE BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "34986",
"telephone_number": "772-878-7078",
"fax_number": "772-343-0608"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-19",
"last_updated": "2023-01-17",
"certification_date": "2023-01-17",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "20592",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "ABILITY Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "CVS PHARMACY #05157",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS PHARMACY #05157",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Port Saint Lucie, FL
- Byron Ian Hoffman, DC
- Chelsea Hoffman, MS, CCC-SLP
- Ross C. Hoffman, L.M.T.
- Kimberly Ann Hogan, M.S. MFC
- Mallory Holguin
- Holiday CVS LLC (CVS Pharmacy #04041)
- Holistic Health on the Go, Inc. (Rachelle Tetreault)
- Sean Mitchell Josiah Holman
- Home of Serenity LLC
- Home Sweet Home Assisted Living by C&a LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.