Active NPI
South Carolina CVS Pharmacy LLC
Doing business as CVS Pharmacy #07568
- Pharmacy
- Goose Creek, SC
National Provider Identifier
1164525606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 50004352
- Legal business name
- SOUTH CAROLINA CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #07568
- Practice address
- 1055 Red Bank Rd
Goose Creek, SC 29445-4520 - Phone
- (843) 572-5707
- NPI assigned
- Sep 7, 2006
- Last updated
- Mar 11, 2014
- 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 Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 50004352 | SC | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1055 Red Bank Rd
Goose Creek, SC 29445-4520
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS PHARMACY #07568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101021000051 | SC | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214130400 | This NPI is an additional NPI on the enrollment |
| O20110726000652 | SC | DME Supplier - Pharmacy | 7214130400 | Practice locations: Goose Creek, SC |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2282307 | South Carolina CVS Pharmacy, LLC | Certificate of waiver | May 18, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| South Carolina 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
- South Carolina CVS Pharmacy
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba CVS Pharmacy #16950
- Pharmacy
- North Charleston, SC
- NPI 1154343804
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1055 Red Bank Rd
Goose Creek, SC 29445
Phone (843) 460-8377
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Pharmacist
- Goose Creek, SC
- NPI 1952847576
-
- Pharmacist
- Goose Creek, SC
- NPI 1114333069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1394496000000",
"number": "1164525606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 RED BANK RD",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "294454520",
"telephone_number": "843-572-5707"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH CAROLINA CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2014-03-11",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "SC",
"license": "50004352",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #07568",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Goose Creek, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; 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.