NPIMap

Organization Active NPI

Oregon CVS Pharmacy LLC

Doing business as CVS Pharmacy #11677

  • Pharmacy
  • Bend, OR
National Provider Identifier
1497864771
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
OREGON CVS PHARMACY LLC
Doing business as
CVS Pharmacy #11677
Rite Aid Pharmacy 05390
Practice address
1900 Northeast Third Street
Suite 111
Bend, OR 97701-3888
Phone
(541) 389-1717
NPI assigned
Aug 30, 2006
Last updated
Sep 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan F Colbert
Title
Sr. Director, Payer Relations
Phone
(401) 770-2751

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X 6773 OR

Addresses

Primary practice location

1900 Northeast Third Street
Suite 111
Bend, OR 97701-3888

Mailing address

1 CVS Dr
Woonsocket, RI 02895-6146

Other names 2

  • CVS Pharmacy #11677 Doing business as
  • RITE AID PHARMACY 05390 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110107000453 OR Part B Supplier - Mass Immunization (Roster Biller Only) 7719979095 This NPI is an additional NPI on the enrollment
O20170104001867 OR Part B Supplier - Mass Immunization (Roster Biller Only) 3476841768 40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Salem, OR; Sherwood, OR; Springfield, OR; Tigard, OR; Wilsonville, OR; Albany, OR; Beaverton, OR…
O20260127000492 OR DME Supplier - Pharmacy 3476841768 Practice locations: Bend, OR

Other NPIs on the same Medicare enrollment 36

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 36

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 1115036 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Member of 1

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

Locations

10775 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005
Phone (503) 207-0646

1900 NE 3rd St
Ste 111
Bend, OR 97701
Phone (541) 389-1717

4575 W 11th Ave
Eugene, OR 97402
Phone (541) 684-4589

21500 NE Halsey St
Fairview, OR 97024
Phone (503) 491-8953

1642 Williams Hwy
Grants Pass, OR 97527
Phone (541) 479-6698

90 B Ave
Lake Oswego, OR 97034
Phone (503) 534-0345

12555 NW Cornell Rd
Portland, OR 97229
Phone (503) 495-4157

3031 SE Powell Blvd
Portland, OR 97202
Phone (503) 231-4756

4030 NE Halsey St
Portland, OR 97232
Phone (503) 327-0988

640 SW Broadway
Portland, OR 97205
Phone (503) 535-6032

9401 NE Cascades Pkwy
Portland, OR 97220
Phone (971) 230-1931

1575 NE 3rd St
Prineville, OR 97754
Phone (541) 447-2466

1514 SW Highland Ave
Redmond, OR 97756
Phone (541) 504-2218

3790 Center St NE
Salem, OR 97301
Phone (503) 588-4433

2750 Gateway St
Springfield, OR 97477
Phone (541) 741-1547

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 53

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1497864771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 NORTHEAST THIRD STREET",
            "address_2": "SUITE 111",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013888",
            "telephone_number": "541-389-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR. 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": "OR",
            "license": "6773",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #11677",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RITE AID PHARMACY 05390",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.

Verify at the official NPI Registry.