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Maryland CVS Pharmacy LLC

Organization Active NPI Pharmacy · Capitol Heights, MD

NPI 1336244169 · NPPES record last updated Mar 23, 2012

Key facts

NPI
1336244169
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
P00518 (MD)
Legal business name
MARYLAND CVS PHARMACY LLC
Practice address
4840 Marlboro Pike
Capitol Heights, MD 20743-5281
Phone
(301) 736-1894
NPI assigned
Sep 14, 2006
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Director, Payer Relations
Phone
(401) 770-2751

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2283806Maryland CVS Pharmacy LLC Dba CVS/Pharmacy #03789
4840 Marlboro Pike, Capitol Heights, MD 20743		Certificate of waiverJun 12, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy # 03789
4840 Marlboro Pike, Capitol Heights, MD 20743-5281 · (301) 669-0465		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in DC, MD

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090928000399 DC Part B Supplier - Mass Immunization (Roster Biller Only) 7719033703 This NPI is an additional NPI on the enrollment
O20100930020387 MD DME Supplier - Pharmacy 7719033703 Practice locations: Capitol Heights, MD

National Provider Directory

Tax ID family
CVS Health (192 organizations share this tax ID)

Locations

4840 Marlboro Pike
Seat Pleasant, MD 20743
Phone (301) 669-0465

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X P00518 MD Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4840 Marlboro Pike
Capitol Heights, MD 20743-5281

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
0900476OtherOTHER ID NUMBER-COMMERCIAL NUMBER
442133700 - RXMedicaidMD

Other names

  • CVS PHARMACY #03789 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 23, 2012.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1336244169",
    "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": "4840 MARLBORO PIKE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207435281",
            "telephone_number": "301-736-1894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2012-03-23",
        "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": "MD",
            "license": "P00518",
            "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": "0900476",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442133700 - RX",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #03789",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Capitol Heights, MD

All providers in Capitol Heights, MD · Pharmacy in Maryland

Sources for this page

Verify at the official NPI Registry.