Georgia CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Lawrenceville, GA
NPI 1154424901 · NPPES record last updated Mar 8, 2011
Key facts
- NPI
- 1154424901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 006991 (GA)
- Legal business name
- GEORGIA CVS PHARMACY, L.L.C.
- Practice address
- 620 W Pike St
Lawrenceville, GA 30045-7699 - Phone
- (770) 339-1802
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000543 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8123161429 | This NPI is an additional NPI on the enrollment |
| O20100930067653 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Lawrenceville, GA |
National Provider Directory
- Tax ID family
- CVS Pharmacy 06861
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 006991 | GA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
620 W Pike St
Lawrenceville, GA 30045-7699
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1138711 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 000529306B | Medicaid | GA |
Other names
- CVS PHARMACY #04737
Other providers in Lawrenceville, GA
- Georgia Cancer Specialists I PC
- Georgia Chiropractic Care, Inc.
- Georgia Comprehensive Family Clinic & Natural Health
- Georgia Comprehensive Family Clinic and Natural Health
- Georgia CVS Pharmacy LLC
- Georgia CVS Pharmacy, L.L.C.
- Georgia CVS Pharmacy, L.L.C.
- Georgia CVS Pharmacy, L.L.C.
- Georgia CVS Pharmacy, L.L.C.
- Georgia Diagnostic Centers
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2011. 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.