Connecticut CVS Pharmacy LLC
Organization Active NPI Pharmacy · Wallingford, CT
NPI 1447537014 · NPPES record last updated Feb 13, 2014
Key facts
- NPI
- 1447537014
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- CONNECTICUT CVS PHARMACY LLC
- Practice address
- 891 N Colony Rd
Wallingford, CT 06492-2437 - Phone
- (203) 294-8890
- NPI assigned
- Nov 10, 2011
- 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 4
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2224165 | Connecticut CVS Pharmacy, LLC | Certificate of waiver | May 11, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Connecticut 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 CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101105000131 | CT | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214139633 | This NPI is an additional NPI on the enrollment |
| O20120316000259 | CT | DME Supplier - Pharmacy | 7214139633 | Practice locations: Wallingford, CT |
National Provider Directory
- Tax ID family
- Connecticut CVS Pharmacy LLC
Locations
891 N Colony Rd
Wallingford, CT 06492
Phone (203) 294-8890
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
891 N Colony Rd
Wallingford, CT 06492-2437
Mailing address
1 CVS Dr
Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008039187 | Other | CT | DME |
| 008036976 | Medicaid | CT | |
| 0722620 | Other | NCPDP |
Other names
- CVS PHARMACY# 00935
Other providers in Wallingford, CT
- Zoe Condon
- Confi Dental LLC
- Connecticut Ambulatory Anesthesia, PLLC
- Connecticut Audiology Partners, PLLC
- Connecticut Behavioral Outreach, Inc.
- Connecticut Infusion Nurses LLC
- Connecticut Neurosurgery, PC
- Connecticut Optometry Partners, PLLC
- Connecticut Orthopaedic Specialists, PC
- Connecticut Orthopaedic Specialists, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2014. 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.