Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy #05236
- Pharmacy
- Fort Myers, FL
National Provider Identifier
1457455362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 20211
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy #05236
- Practice address
- 9170 Daniels Pkwy
Fort Myers, FL 33912-1815 - Phone
- (239) 561-5151
- Fax
- (239) 561-5502
- NPI assigned
- Sep 12, 2006
- 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
- Director Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 20211 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
9170 Daniels Pkwy
Fort Myers, FL 33912-1815
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1097749 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #05236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20100930099087 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Fort Myers, FL |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2285384 | Holiday CVS LLC | Certificate of waiver | Jul 10, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #05236 | Immunosuppressive 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|Urological Supplies|Ent… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Holiday CVS 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
9170 Daniels Pkwy
Fort Myers, FL 33912
Phone (239) 561-5151
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacy
- Fort Myers, FL
- NPI 1871189225
-
- Pharmacist
- Fort Myers, FL
- NPI 1215530803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1332115200000",
"number": "1457455362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9170 DANIELS PKWY",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339121815",
"telephone_number": "239-561-5151",
"fax_number": "239-561-5502"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2012-03-19",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "20211",
"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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1097749",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #05236",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Myers, FL
- Heather Nicole Holfinger, FNP-C
- Holiday CVS LLC (CVS Pharmacy 05116)
- Holiday CVS LLC (CVS Pharmacy# 00196)
- Holiday CVS LLC (CVS Pharmacy #17427)
- Holiday CVS LLC (CVS Pharmacy #07983)
- Holiday CVS LLC (CVS Pharmacy 03433)
- Holiday CVS LLC (CVS Pharmacy 03296)
- Holiday CVS LLC (CVS Pharmacy #03616)
- Holiday CVS LLC (CVS Pharmacy #03941)
- Holiday CVS LLC (CVS Pharmacy #07890)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.