Active NPI
Idaho CVS Pharmacy LLC
- Pharmacy
- Nampa, ID
National Provider Identifier
1336249648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- IDAHO CVS PHARMACY LLC
- Practice address
- 16300 N Marketplace Blvd
Nampa, ID 83687-7910 - Phone
- (208) 465-6801
- Fax
- (208) 465-6811
- NPI assigned
- Sep 25, 2006
- 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
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X | 41103RP | ID |
Addresses
Primary practice location
16300 N Marketplace Blvd
Nampa, ID 83687-7910
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021945 | Other | PK |
Other names 1
- CVS Pharmacy #17284
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160810001654 | ID | DME Supplier - Pharmacy | 8527352772 | Practice locations: Nampa, ID |
| O20161101001987 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527352772 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boise, ID; Lewiston, ID; Nampa, ID; Twin Falls, ID |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
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 #17284 | 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… | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- CVS Pharmacy 11169
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pharmacy
- Boise, ID
- NPI 1265912901
-
- Pharmacy
- Twin Falls, ID
- NPI 1841212636
-
- Pharmacy
- Lewiston, ID
- NPI 1982626891
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1479686400000",
"number": "1336249648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16300 N MARKETPLACE BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836877910",
"telephone_number": "208-465-6801",
"fax_number": "208-465-6811"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IDAHO CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2016-11-21",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. 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": null,
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ID",
"license": "41103RP",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2021945",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #17284",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Nampa, ID
- Tyler Akira Ice
- Idaho Advanced Imaging PA
- Idaho Arts Charter School
- Idaho Center Dental Care
- Idaho Counseling Center LLP
- Idaho Dental Aid PLLC
- Idaho Dental Aid, PLLC
- Idaho Department of Health & Welfare
- Idaho Department of Health and Welfare Esc Region III
- Idaho Dept of Health & Welfare Itp Region 3
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.