Mississippi CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Jackson, MS
NPI 1144329459 · NPPES record last updated Jan 17, 2023
Key facts
- NPI
- 1144329459
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 00815/01.2 (MS)
- Legal business name
- MISSISSIPPI CVS PHARMACY, L.L.C.
- Practice address
- 2803 Suncrest Dr
Jackson, MS 39212-2529 - Phone
- (601) 373-2111
- Fax
- (601) 372-7846
- NPI assigned
- Sep 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 47
Member of 1
Practitioners 2
-
Kimberly Evon Dowd-Davis, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #05745 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930058483 | MS | DME Supplier - Pharmacy | 9335344456 | Practice locations: Jackson, MS |
| O20101230001038 | MS | Part B Supplier - Mass Immunization (Roster Biller Only) | 9335344456 |
This NPI is an additional NPI on the enrollment Practice locations: Picayune, MS; Pascagoula, MS; Oxford, MS; Olive Branch, MS; Ocean Springs, MS; Natchez, MS; Laurel, MS; Meridian, MS… |
National Provider Directory
- Tax ID family
- Mississippi CVS Pharmacy LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 00815/01.2 | MS | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2803 Suncrest Dr
Jackson, MS 39212-2529
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2501129 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 000330336 | Medicaid | MS |
Other names
- CVS PHARMACY # 05745
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
Other providers in Jackson, MS
- Mississippi Comprehensive Treatment Centers, LLC
- Mississippi Counseling Associates
- Mississippi Counseling Center
- Mississippi Counseling Center,Corp
- Mississippi CVS Pharmacy LLC
- Mississippi CVS Pharmacy, L.L.C.
- Mississippi CVS Pharmacy, L.L.C.
- Mississippi Dental Center of Jackson LLC
- Mississippi Department of Rehabilitaion Services
- Mississippi Department of Rehabilitaion SVS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.