NPIMap

Organization Active NPI

Pennsylvania CVS Pharmacy LLC

  • Pharmacy
  • Johnstown, PA
National Provider Identifier
1467835546
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
PENNSYLVANIA CVS PHARMACY LLC
Practice address
1650 Menoher Blvd
Johnstown, PA 15905-2000
Phone
(814) 255-2792
NPI assigned
Jul 7, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Susan F Colbert
Title
Director
Phone
(401) 770-2751

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Pennsylvania CVS Pharmacy LLC1650 Menoher Blvd, Johnstown, PA 15905-2000(814) 255-2792 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 assignmentParticipating since Dec 27, 2024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080116000450 PA Part B Supplier - Mass Immunization (Roster Biller Only) 8527149566 This NPI is an additional NPI on the enrollment
O20151026000699 PA DME Supplier - Pharmacy 8527149566 Practice locations: Johnstown, PA

National Provider Directory

National Provider Directory
Tax ID family
Pennsylvania CVS Pharmacy LLC431 organizations share this tax ID, including this one

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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1650 Menoher Blvd
Johnstown, PA 15905
Phone (814) 255-2792

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

NPPES NPI Registry

Primary practice location

1650 Menoher Blvd
Johnstown, PA 15905-2000

Mailing address

1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
6002478OtherPANCPDP
1467835546 PACEMedicaidPA

Other names 1

NPPES NPI Registry
  • CVS PHARMACY 10249 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 4, 2015.

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1467835546",
    "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": "1650 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159052000",
            "telephone_number": "814-255-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR",
        "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": "NCPDP",
            "identifier": "6002478",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467835546   PACE",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY 10249",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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.

Verify at the official NPI Registry.