Active NPI
Tennessee CVS Pharmacy LLC
Doing business as CVS Pharmacy #07655
- Pharmacy
- Elizabethton, TN
National Provider Identifier
1265535819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 3189
- Legal business name
- TENNESSEE CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #07655
- Practice address
- 1161 US Hwy 19 E
Elizabethton, TN 37643-4680 - Phone
- (423) 547-1991
- Fax
- (423) 547-0110
- NPI assigned
- Sep 7, 2006
- Last updated
- May 2, 2024
- 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 F Colbert
- Title
- Sr Director, Payer Relations
- Phone
- (800) 764-7287
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 3189 | TN | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1161 US Hwy 19 E
Elizabethton, TN 37643-4680
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4430839 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS Pharmacy #07655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101110000381 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 3476756560 | This NPI is an additional NPI on the enrollment |
| O20110913000186 | TN | DME Supplier - Pharmacy | 3476756560 | Practice locations: Elizabethton, TN |
National Provider Directory
National Provider Directory- Tax ID family
- Tennessee CVS Pharmacy 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
1161 Highway 19E Byp
Elizabethton, TN 37643
Phone (423) 547-1991
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": "1714608000000",
"number": "1265535819",
"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",
"fax_number": "401-735-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1161 US HWY 19 E",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376434680",
"telephone_number": "423-547-1991",
"fax_number": "423-547-0110"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TENNESSEE CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "SR DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "800-764-7287"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "TN",
"license": "3189",
"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": "4430839",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #07655",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Elizabethton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.