Active NPI
Wisconsin CVS Pharmacy LLC
Doing business as CVS Pharmacy #16066
- Pharmacy
- Appleton, WI
National Provider Identifier
1376899120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- WISCONSIN CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #16066
- Practice address
- 4301 W Wisconsin Ave Ste 42
Appleton, WI 54913-6524 - Phone
- (920) 243-7877
- NPI assigned
- Jul 31, 2012
- Last updated
- Dec 5, 2016
- 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 | 915142 | WI |
Addresses
Primary practice location
4301 W Wisconsin Ave Ste 42
Appleton, WI 54913-6524
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2136228 | Other | PK |
Other names 1
- CVS Pharmacy #16066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080110000070 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 1658451059 | This NPI is an additional NPI on the enrollment |
| O20161121001374 | WI | DME Supplier - Pharmacy | 1658451059 | Practice locations: Appleton, WI |
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 |
|---|---|---|
| Wisconsin CVS Pharmacy LLC | 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
- Wisconsin CVS Pharmacy LLC
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
4301 W Wisconsin Ave
Ste 42
Appleton, WI 54913
Phone (920) 243-7877
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Appleton, WI
- NPI 1366828360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343692800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1480896000000",
"number": "1376899120",
"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": "4301 W WISCONSIN AVE STE 42",
"city": "APPLETON",
"state": "WI",
"postal_code": "549136524",
"telephone_number": "920-243-7877"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WISCONSIN CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-07-31",
"last_updated": "2016-12-05",
"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": "WI",
"license": "915142",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2136228",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #16066",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Appleton, WI
- Judy Winkler
- Caura Winters
- Elizabeth Wischer, NP
- Wisconsin Community Care LLC
- Wisconsin CVS Pharmacy LLC (CVS Pharmacy #16596)
- Wisconsin CVS Pharmacy LLC (CVS Pharmacy #08525)
- Wisconsin CVS Pharmacy LLC (CVS Pharmacy# 05186)
- Wisconsin Dental Group, S.C. (ForwardDental Appleton)
- Wisconsin Institute of Ambulatory Surgery
- Wisconsin Institute of Plastic Surgery SC (Wisconsin Oculoplastics SC)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.