Active NPI
Wisconsin CVS Pharmacy LLC
Doing business as CVS Pharmacy #04996
- Pharmacy
- Menomonee Falls, WI
National Provider Identifier
1396014908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- WISCONSIN CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #04996
- Practice address
- N83 W15550 Appleton Avenue
Menomonee Falls, WI 53051 - Phone
- (262) 253-5056
- NPI assigned
- Dec 28, 2011
- Last updated
- Mar 7, 2023
- 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 F Colbert
- Title
- 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 |
Addresses
Primary practice location
N83 W15550 Appleton Avenue
Menomonee Falls, WI 53051
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (262) 253-5056
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9112-42 | Other | WI | PHARMACY STATE LICENSE |
| 1396014908 | Medicaid | WI | |
| 5132977 | Other | WI | NCPDP |
Other names 1
- CVS PHARMACY #04996
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
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 |
| O20120329000890 | WI | DME Supplier - Pharmacy | 1658451059 | Practice locations: Menomonee Falls, WI |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325030400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1396014908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "262-253-5056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N83 W15550 APPLETON AVENUE",
"city": "MENOMONEE FALLS",
"state": "WI",
"postal_code": "53051",
"telephone_number": "262-253-5056"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WISCONSIN CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-12-28",
"last_updated": "2023-03-07",
"certification_date": "2023-01-17",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"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": null,
"license": null,
"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": "PHARMACY STATE LICENSE",
"identifier": "9112-42",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1396014908",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "5132977",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "ABILITY Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "CVS PHARMACY #04996",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS PHARMACY #04996",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Menomonee Falls, WI
- Samantha J Williams, OTR/L
- Mary Kay Winarski, NP
- Amber Winquist-Bailey, DPT
- Salina Winslow, PTA
- Wisconsin Athletic Club, LLC
- Wisconsin CVS Pharmacy LLC (CVS Pharmacy #16301)
- Wisconsin Dental Group, S.C. (ForwardDental Menomonee Falls)
- Wisconsin Vision, LLC
- Laura A Wittlin, MS, RD CD
- Brittany Marie Wohlfeil, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.