Active NPI
Louisiana CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy 05354
- Pharmacy
- Gonzales, LA
National Provider Identifier
1265536106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5365
- Legal business name
- LOUISIANA CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy 05354
- Practice address
- 1624 N Burnside Ave
Gonzales, LA 70737-2139 - Phone
- (225) 644-7528
- Fax
- (225) 647-3949
- NPI assigned
- Sep 12, 2006
- Last updated
- Dec 15, 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
- Director Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 5365 | LA | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1624 N Burnside Ave
Gonzales, LA 70737-2139
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1917004 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 001264920 | Medicaid | LA |
Other names 1
- CVS PHARMACY 05354
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930082035 | LA | DME Supplier - Pharmacy | 7113120312 | Practice locations: Gonzales, LA |
| O20101011000003 | LA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7113120312 | This NPI is an additional NPI on the enrollment |
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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #05354 | 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
- 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.
-
- Pharmacist
- Morgan City, LA
- NPI 1144504432
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Gonzales, LA
- NPI 1083084156
-
- Pharmacist
- Gonzales, LA
- NPI 1144709163
-
- Pharmacist
- Gonzales, LA
- NPI 1558644369
-
- Pharmacist
- Gonzales, LA
- NPI 1275882748
-
- Pharmacist
- Gonzales, LA
- NPI 1750714663
-
- Pharmacist
- Gonzales, LA
- NPI 1013290279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1418601600000",
"number": "1265536106",
"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",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1624 N BURNSIDE AVE",
"city": "GONZALES",
"state": "LA",
"postal_code": "707372139",
"telephone_number": "225-644-7528",
"fax_number": "225-647-3949"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOUISIANA CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2014-12-15",
"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": "LA",
"license": "5365",
"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": "1917004",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001264920",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 05354",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.