Georgia CVS Pharmacy LLC
Organization Active NPI Pharmacy · Griffin, GA
NPI 1366545121 · NPPES record last updated Mar 7, 2012
Key facts
- NPI
- 1366545121
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 007785 (GA)
- Legal business name
- GEORGIA CVS PHARMACY LLC
- Practice address
- 736 S Hill St
Griffin, GA 30224-4831 - Phone
- (770) 229-2113
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2255739 | Georgia CVS Pharmacy, LLC Dba CVS/Pharmacy #04404 | Certificate of waiver | Mar 16, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #04404 |
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 |
| O20110429000138 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Griffin, GA |
National Provider Directory
- Tax ID family
- CVS Pharmacy 06861
Locations
818 S Hill St
Griffin, GA 30224
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 007785 | GA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
736 S Hill St
Griffin, GA 30224-4831
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000629604A | Medicaid | GA | |
| 1140677 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY # 04404
Other providers in Griffin, GA
- Genesis Horizon Tester LLC
- Genesis Horizon Tester LLC
- Genesis Horizon Tester LLC
- Georgia Assessment and Therapy Enterprises LLC
- Georgia Cancer Specialists I PC
- Georgia Emergency Group, LLC
- Georgia Hospitalists Group, LLC
- Georgia Rehabilitation Specialists, LLC
- Georgia Vascular & Interventional, LLC
- Brittney Gethers
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2012. 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.