Georgia CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Watkinsville, GA
NPI 1356444103 · NPPES record last updated Jan 31, 2021
Key facts
- NPI
- 1356444103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 006992 (GA)
- Legal business name
- GEORGIA CVS PHARMACY, L.L.C.
- Practice address
- 2080 Hog Mountain Rd
Watkinsville, GA 30677-1953 - Phone
- (706) 769-8031
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Practitioners 2
-
Vickie Adams Evans, RPH
-
William Rhett Hickox, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2281659 | Georgia CVS Pharmacy, LLC | Certificate of waiver | May 9, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Georgia CVS Pharmacy, L.L.C. |
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 GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000543 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8123161429 | This NPI is an additional NPI on the enrollment |
| O20100930031993 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Watkinsville, GA |
National Provider Directory
- Tax ID family
- CVS Pharmacy 06861
Locations
2080 Hog Mountain Rd
Watkinsville, GA 30677
Phone (706) 769-8030
2061 Hog Mountain Rd
Ste A
Watkinsville, GA 30677
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 006992 | GA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2080 Hog Mountain Rd
Watkinsville, GA 30677-1953
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134321 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 000388814A | Medicaid | GA |
Other names
- CVS PHARMACY #04719
Other providers in Watkinsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2021. 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.