Active NPI
Mississippi CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy # 11085
- Pharmacy
- Holly Springs, MS
National Provider Identifier
1154421154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- MISSISSIPPI CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy # 11085
- Practice address
- 575 Craft Ave
Holly Springs, MS 38635-3249 - Phone
- (662) 252-2285
- Fax
- (662) 252-2394
- NPI assigned
- Sep 22, 2006
- Last updated
- Jul 21, 2022
- 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 F. Colbert
- Title
- Sr. Director
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | MS | ||
| Pharmacy | 333600000X | MS | Primary | |
| Community/Retail Pharmacy | 3336C0003X | MS |
Addresses
Primary practice location
575 Craft Ave
Holly Springs, MS 38635-3249
Mailing address
One CVS Drive Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS Pharmacy # 11085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20171004000669 | MS | DME Supplier - Pharmacy | 9335344456 | Practice locations: Holly Springs, MS |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Mississippi CVS Pharmacy LLC | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Mississippi CVS Pharmacy LLC
Other organizations with this tax ID 47
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 & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Registered Dietitian
- Holly Springs, MS
- NPI 1598164147
-
- Pharmacist
- Holly Springs, MS
- NPI 1932798469
-
- Pharmacist
- Holly Springs, MS
- NPI 1760144307
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1154421154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE CVS DRIVE BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 CRAFT AVE",
"city": "HOLLY SPRINGS",
"state": "MS",
"postal_code": "386353249",
"telephone_number": "662-252-2285",
"fax_number": "662-252-2394"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MISSISSIPPI CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-22",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F.",
"authorized_official_title_or_position": "SR. DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "MS",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MS",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MS",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy # 11085",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Holly Springs, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.