Mississippi CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Holly Springs, MS
NPI 1154421154 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1154421154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- MISSISSIPPI CVS PHARMACY, L.L.C.
- Practice address
- 575 Craft Ave
Holly Springs, MS 38635-3249 - Phone
- (662) 252-2285
- Fax
- (662) 252-2394
- NPI assigned
- Sep 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan F. Colbert
- Title
- Sr. Director
- Phone
- (401) 765-1500
Corporate family (same tax ID) 47
Member of 1
Practitioners 3
-
Christopher Martin Liddy, R.D.
-
Timothy L Liddy, RPH
Laboratory certificates & supplier records
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Medicare enrollment records
| 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 |
National Provider Directory
- Tax ID family
- Mississippi CVS Pharmacy LLC
Locations
575 Craft St
Holly Springs, MS 38635
Phone (662) 252-2285
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | MS | ||
| Pharmacy | 333600000X | MS | Yes | |
| 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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302G735488 | Other | MS | MASS IMM |
| 00330511 | Medicaid | MS | |
| 5983700059 | Other | MS | MEDICARE B |
| 2516269 | Other | MS | NCPDP |
Other names
- CVS Pharmacy # 11085
Other providers in Holly Springs, MS
- Kayla Nicole McGregor
- Memphis Vamc
- April Michelle Miller
- Ashley Miller
- Debe Milton
- Mississippi Pac Services Professional Association
- Mississippi State Department of Health
- Brooks V Monaghan Jr.
- Malika Moody
- Moral Lyft
All providers in Holly Springs, MS · Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.