NPIMap

Organization Active NPI

Oklahoma CVS Pharmacy LLC

  • Pharmacy
  • Yukon, OK
National Provider Identifier
1215035936
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
26-5406 Issued in OK
Legal business name
OKLAHOMA CVS PHARMACY LLC
Practice address
201 Smustang Rd
Yukon, OK 73099
Phone
(405) 324-8170
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan F Colbert
Title
Director, Payer Relations
Phone
(401) 770-2751

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X OK
Pharmacy 333600000X 26-5406 OK Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

201 Smustang Rd
Yukon, OK 73099

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 1

IdentifierTypeStateIssuer
3724211OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • CVS PHARMACY #08312 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100903000320 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1759405350 This NPI is an additional NPI on the enrollment
O20100930020832 OK DME Supplier - Pharmacy 1759405350 Practice locations: Yukon, OK

National Provider Directory

National Provider Directory
Tax ID family
Oklahoma CVS Pharmacy LLC60 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1215035936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "PO 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": "201 SMUSTANG RD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-324-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "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": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OK",
            "license": "26-5406",
            "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": "3724211",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #08312",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.