Holiday CVS LLC
Organization Active NPI Pharmacy · Panama City, FL
NPI 1275637142 · NPPES record last updated Dec 14, 2012
Key facts
- NPI
- 1275637142
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 20111 (FL)
- Legal business name
- HOLIDAY CVS LLC
- Practice address
- 955 W 23Rd St
Panama City, FL 32405-3928 - Phone
- (850) 769-3366
- Fax
- (850) 769-8015
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director Phcy Enrollments
- Phone
- (401) 770-2937
Corporate family (same tax ID) 24
Member of 1
Practitioners 3
-
Valerie Sims, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2259511 | Holiday CVS LLC Dba CVS/Pharmacy #5204 | Certificate of waiver | May 5, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Holiday CVS LLC |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20100930048450 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Panama City, FL |
National Provider Directory
- Tax ID family
- Holiday CVS LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 20111 | FL | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
955 W 23Rd St
Panama City, FL 32405-3928
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021440000 | Medicaid | FL | |
| 1085946 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY 05204
Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.