CVS Pharmacy Inc
Organization Active NPI Pharmacy · Longview, TX
NPI 1164526984 · NPPES record last updated Feb 26, 2015
Key facts
- NPI
- 1164526984
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 24602 (TX)
- Legal business name
- CVS PHARMACY INC
- Practice address
- 1754 W Loop 281
Longview, TX 75604-2733 - Phone
- (903) 759-3816
- Fax
- (903) 297-7172
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Cristiana Mauricio
- Title
- MGR Phcy Enrollments
- Phone
- (401) 770-2937
Corporate family (same tax ID) 24
Practitioners 2
-
Chiyah Boma Ngehnevu, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2256263 | CVS Pharmacy, Inc Dba CVS/Pharmacy #06899 | Certificate of waiver | Mar 21, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy # 6899 |
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 TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090408000170 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092711895 | This NPI is an additional NPI on the enrollment |
| O20100930062057 | TX | DME Supplier - Pharmacy | 5092711895 | Practice locations: Longview, TX |
National Provider Directory
- Tax ID family
- CVS Pharmacy Inc Agent for CVS RX Services Inc
Locations
1754 W Loop 281
Longview, TX 75604
Phone (903) 759-3816
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 24602 | TX | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1754 W Loop 281
Longview, TX 75604-2733
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00754740 | Other | MEDICARE RR | |
| 000460722 | Medicaid | TX | |
| 4511259 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY #6899
Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2015. 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.