NPIMap

Organization Active NPI

Connecticut CVS Pharmacy LLC

  • Pharmacy
  • Lisbon, CT
National Provider Identifier
1508091315
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
CONNECTICUT CVS PHARMACY LLC
Practice address
195 River Rd
Lisbon, CT 06351-3253
Phone
(860) 823-2961
Fax
(860) 591-3002
NPI assigned
May 22, 2009
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

Member of 1

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

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
Connecticut CVS Pharmacy LLC195 River Rd, Lisbon, CT 06351-3253(860) 823-2961 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 assignmentParticipating since Jan 1, 2025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20101105000131 CT Part B Supplier - Mass Immunization (Roster Biller Only) 7214139633 This NPI is an additional NPI on the enrollment
O20160907001678 CT DME Supplier - Pharmacy 7214139633 Practice locations: Lisbon, CT

National Provider Directory

National Provider Directory
Tax ID family
Connecticut CVS Pharmacy LLC (167 organizations share this tax ID)

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X PCY.0002143 CT

Addresses

NPPES NPI Registry

Primary practice location

195 River Rd
Lisbon, CT 06351-3253

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
2120069OtherPK

Other names 1

NPPES NPI Registry
  • CVS Pharmacy #17490 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 Oct 5, 2016.

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1508091315",
    "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": "195 RIVER RD",
            "city": "LISBON",
            "state": "CT",
            "postal_code": "063513253",
            "telephone_number": "860-823-2961",
            "fax_number": "860-591-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-22",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "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": "CT",
            "license": "PCY.0002143",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120069",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #17490",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisbon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.