Maryland CVS Pharmacy LLC
Organization Active NPI Pharmacy · College Park, MD
NPI 1306374368 · NPPES record last updated Jul 18, 2024
Key facts
- NPI
- 1306374368
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- MARYLAND CVS PHARMACY LLC
- Practice address
- 8319 Baltimore Ave
College Park, MD 20740-2435 - Phone
- (301) 220-3860
- Fax
- (301) 476-4838
- NPI assigned
- Jun 2, 2017
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Sr Director-Payer Relations
- Phone
- (401) 765-1500
Corporate family (same tax ID) 24
Member of 1
Practitioners 4
-
Emmanuel Oppong, PHARMD
-
Dasia Simmons, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy # 10168 |
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 DC, MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090928000399 | DC | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719033703 | This NPI is an additional NPI on the enrollment |
| O20170829000212 | MD | DME Supplier - Pharmacy | 7719033703 | Practice locations: College Park, MD |
National Provider Directory
- Tax ID family
- CVS Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
8319 Baltimore Ave
College Park, MD 20740-2435
Mailing address
1 CVS Dr
Woonsocket, RI 02895-6146
Other names
- CVS PHARMACY # 10168
Other providers in College Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2024. 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.