Pennsylvania CVS Pharmacy, L.L.C.

Primary specialty

PharmacyTaxonomy code 333600000X

License

PP410816L Issued in PA

Legal business name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Practice address

1216 West 6TH St
Erie, PA 16507-1022

Phone

(814) 844-6265

Fax

(814) 459-0237

NPI assigned

Dec 22, 2005

Organization subpart

No

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

(401) 770-2751

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CVS Pharmacy #11421 Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

These 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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Frances Schmude, DOCTOR

  • Pharmacist
  • Erie, PA
  • NPI 1053906255
  NPD
• Regina Wunch, PHARMD

  • Pharmacist
  • Erie, PA
  • NPI 1982209979
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1295712065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DRIVE",
            "address_2": "BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500",
            "fax_number": "814-459-0237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 WEST 6TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071022",
            "telephone_number": "814-844-6265",
            "fax_number": "814-459-0237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "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": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP410816L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100750747",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #11421",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pennsylvania CVS Pharmacy LLC
• Pennsylvania CVS Pharmacy LLC
• Pennsylvania CVS Pharmacy LLC
• Pennsylvania CVS Pharmacy LLC
• Pennsylvania CVS Pharmacy, L.L.C
• Pennsylvania CVS Pharmacy, L.L.C.
• Pennsylvania Department of Military and Veterans' Affairs
• Pennsylvania Physicians Eyecare Group, P.C.
• Erica Penny-Peterson
• Carrie M Penpek, LPC

• Pharmacy in Erie, PA
• Providers in Erie, PA by specialty
• Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; 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.

Verify at the official NPI Registry.