Active NPI
South Carolina CVS Pharmacy LLC
Doing business as CVS Pharmacy #05524
- Pharmacy
- Little River, SC
National Provider Identifier
1255434932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5004349
- Legal business name
- SOUTH CAROLINA CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #05524
- Practice address
- 1370 Highway 17
Little River, SC 29566-9219 - Phone
- (843) 249-7618
- NPI assigned
- Sep 7, 2006
- Last updated
- Jan 17, 2023
- 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 | 5004349 | SC | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1370 Highway 17
Little River, SC 29566-9219
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS PHARMACY #05524
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
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 |
| O20110823000289 | SC | DME Supplier - Pharmacy | 7214130400 | Practice locations: Little River, SC |
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.
-
- Community/Retail Pharmacy
- Columbia, SC
- NPI 1255680138
-
dba CVS Pharmacy #07396
- Pharmacy
- North Myrtle Beach, SC
- NPI 1255434791
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": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1673913600000",
"number": "1255434932",
"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": "1370 HIGHWAY 17",
"city": "LITTLE RIVER",
"state": "SC",
"postal_code": "295669219",
"telephone_number": "843-249-7618"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH CAROLINA CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2023-01-17",
"certification_date": "2023-01-17",
"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": "5004349",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "ABILITY Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "CVS PHARMACY #05524",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS PHARMACY #05524",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Little River, SC
- Asad Farooq Shaikh, MD
- Christopher Allen Shumate, D.C.
- Michelle Allene Singletary, FNP
- Jillian M. Siniscalchi, AGP-NP
- Annette Marie Magyar Smith, OTR/L
- South Carolina CVS Pharmacy LLC (CVS Pharmacy #07040)
- South Carolina Em-1 Medical Services, PC
- South Carolina Podiatric Physicians and Surgeons Group, LLC
- South Carolina Podiatric Physicians and Surgeons Group, LLC
- Southern Spinal Care, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.