Active NPI
Ohio CVS Stores LLC
Doing business as CVS Pharmacy #04807
- Pharmacy
- Streetsboro, OH
National Provider Identifier
1184727919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 2868250
- Legal business name
- OHIO CVS STORES LLC
- Doing business as
- CVS Pharmacy #04807
- Practice address
- 9940 State Route 43
Streetsboro, OH 44241-4938 - Phone
- (330) 626-1866
- NPI assigned
- Sep 7, 2006
- 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
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 2868250 | OH | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
9940 State Route 43
Streetsboro, OH 44241-4938
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3661558 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #04807
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101111000369 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 4981806023 | This NPI is an additional NPI on the enrollment |
| O20110418000494 | OH | DME Supplier - Pharmacy | 4981806023 | Practice locations: Streetsboro, OH |
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 |
|---|---|---|---|
| 36D2279444 | Ohio CVS Stores, LLC | Certificate of waiver | Apr 2, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #04807 | 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
- Ohio CVS Stores LLC
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
9940 State Route 43
Streetsboro, OH 44241
Phone (330) 626-1866
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": "1319500800000",
"number": "1184727919",
"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": "9940 STATE ROUTE 43",
"city": "STREETSBORO",
"state": "OH",
"postal_code": "442414938",
"telephone_number": "330-626-1866"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OHIO CVS STORES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2011-10-25",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "OH",
"license": "2868250",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3661558",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #04807",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Streetsboro, OH
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.