Pennsylvania CVS Pharmacy LLC
Organization Active NPI Pharmacy · Lebanon, PA
NPI 1124126735 · NPPES record last updated Feb 28, 2026
Key facts
- NPI
- 1124126735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- PP414171L (PA)
- Legal business name
- PENNSYLVANIA CVS PHARMACY LLC
- Practice address
- 1760 Quention Rd Cedar Crest Square
Lebanon, PA 17042 - Phone
- (717) 273-7824
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Dir Phcy Enrollments
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Practitioners 2
-
Patricia Ann Maier, RPH
-
Gregory Richard Miller, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080116000450 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527149566 | This NPI is an additional NPI on the enrollment |
| O20100930042598 | PA | DME Supplier - Pharmacy | 8527149566 | Practice locations: Lebanon, PA |
National Provider Directory
- Tax ID family
- Pennsylvania CVS Pharmacy LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | PP414171L | PA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1760 Quention Rd Cedar Crest Square
Lebanon, PA 17042
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names
- CVS PHARMACY #01914
Other providers in Lebanon, PA
- Pennsylvania Counseling Services Inc.
- Pennsylvania Counseling Services, Inc.
- Pennsylvania Counseling Services, Inc.
- Pennsylvania Counseling Services, Inc.
- Pennsylvania Counseling Services, Inc.
- Pennsylvania CVS Pharmacy LLC
- Pennsylvania CVS Pharmacy, L.L.C.
- Pennsylvania CVS Pharmacy, L.L.C.
- Ruben Perez
- Wanda Garrett Perez
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2026. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.