Active NPI
Pennsylvania CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy #01323
- Pharmacy
- Pottsville, PA
National Provider Identifier
1265530976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PP413600L
- Legal business name
- PENNSYLVANIA CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy #01323
- Practice address
- 1544 Route 61 Hwy S Ste 6145
Pottsville, PA 17901-4219 - Phone
- (570) 385-4201
- NPI assigned
- Sep 20, 2006
- Last updated
- Sep 11, 2014
- 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
- Supervisor, Pharmacy Enrollments
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | PP413600L | PA | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
1544 Route 61 Hwy S Ste 6145
Pottsville, PA 17901-4219
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3961287 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #01323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080116000450 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527149566 | This NPI is an additional NPI on the enrollment |
| O20100930033493 | PA | DME Supplier - Pharmacy | 8527149566 | Practice locations: Pottsville, PA |
National Provider Directory
National Provider Directory- Tax ID family
- Pennsylvania CVS Pharm
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
1544 Route 61 Hwy S
Ste 6145
Pottsville, PA 17901
Phone (570) 385-4201
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": "1410393600000",
"number": "1265530976",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1544 ROUTE 61 HWY S STE 6145",
"city": "POTTSVILLE",
"state": "PA",
"postal_code": "179014219",
"telephone_number": "570-385-4201"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PENNSYLVANIA CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2014-09-11",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SUPERVISOR, PHARMACY ENROLLMENTS",
"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": "PA",
"license": "PP413600L",
"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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3961287",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #01323",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pottsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.