Active NPI
Mississippi CVS Pharmacy LLC
Doing business as CVS Pharmacy # 03426
- Pharmacy
- Walls, MS
National Provider Identifier
1174798417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- MISSISSIPPI CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy # 03426
- Practice address
- 6040 Goodman Rd
Walls, MS 38680 - Phone
- (401) 765-1500
- NPI assigned
- Apr 28, 2008
- Last updated
- Oct 25, 2011
- 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 | NU | ||
| Pharmacy | 333600000X | NU | Primary | |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
6040 Goodman Rd
Walls, MS 38680
Mailing address
1 CVS Dr
Box 1075- Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2587181 | Other | NCPDP | |
| 06773354 | Medicaid | MS |
Other names 1
- CVS Pharmacy # 03426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930086009 | MS | DME Supplier - Pharmacy | 9335344456 | Practice locations: Walls, MS |
| 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… |
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 |
|---|---|---|---|
| 25D2223588 | Mississippi CVS Pharmacy LLC Dba CVS Pharmacy03426 | Certificate of waiver | May 6, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #03426 | 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.
Locations
6040 Goodman Rd
Walls, MS 38680
Phone (662) 781-1290
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209340800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1319500800000",
"number": "1174798417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075- PHARMACY ENROLLMENTS",
"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": "6040 GOODMAN RD",
"city": "WALLS",
"state": "MS",
"postal_code": "38680",
"telephone_number": "401-765-1500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MISSISSIPPI CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-28",
"last_updated": "2011-10-25",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "2587181",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06773354",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy # 03426",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Walls, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; 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.