Mississippi CVS Pharmacy, LLC
Organization Active NPI Pharmacy · Diamondhead, MS
NPI 1487043527 · NPPES record last updated Sep 21, 2015
Key facts
- NPI
- 1487043527
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- MISSISSIPPI CVS PHARMACY, LLC
- Practice address
- 4422 Kalani Dr
Diamondhead, MS 39525-3321 - Phone
- (228) 255-7343
- NPI assigned
- Jan 13, 2015
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director
- Phone
- (401) 765-1500
Corporate family (same tax ID) 47
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #10755 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101230001038 | MS | Part B Supplier - Mass Immunization (Roster Biller Only) | 9335344456 |
This NPI is an additional NPI on the enrollment Practice locations: Picayune, MS; Pascagoula, MS; Oxford, MS; Olive Branch, MS; Ocean Springs, MS; Natchez, MS; Laurel, MS; Meridian, MS… |
| O20150409000546 | MS | DME Supplier - Pharmacy | 9335344456 | Practice locations: Diamondhead, MS |
National Provider Directory
- Tax ID family
- Mississippi CVS Pharmacy LLC
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
4422 Kalani Dr
Diamondhead, MS 39525-3321
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00030634 | Medicaid | MS | |
| 2590051 | Other | MS | NCPDP |
| 00023721 DME | Medicaid | MS |
Other names
- CVS PHARMACY # 10755
Other providers in Diamondhead, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2015. 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.