NPIMap

Georgia CVS Pharmacy LLC

Organization Active NPI Pharmacy · Vidalia, GA

NPI 1508969346 · NPPES record last updated Sep 8, 2011

Key facts

NPI
1508969346
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
006530 (GA)
Legal business name
GEORGIA CVS PHARMACY LLC
Practice address
1201 East First St
Vidalia, GA 30474-5500
Phone
(912) 537-8767
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
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

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #07717
1201 E First Street, Vidalia, GA 30474-5500 · (912) 537-8766		 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 assignment
Participating since Dec 24, 2024

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in GA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100209000543 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8123161429 This NPI is an additional NPI on the enrollment
O20110503000540 GA DME Supplier - Pharmacy 8123161429 Practice locations: Vidalia, GA

National Provider Directory

Tax ID family
CVS Pharmacy 06861 (290 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X GA
Pharmacy 333600000X 006530 GA Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1201 East First St
Vidalia, GA 30474-5500

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
000312089AMedicaidGA
1129471OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY # 07717 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 8, 2011.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1508969346",
    "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",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 EAST FIRST ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304745500",
            "telephone_number": "912-537-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2011-09-08",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "006530",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000312089A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1129471",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY # 07717",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, GA

All providers in Vidalia, GA · Pharmacy in Georgia

Sources for this page

Verify at the official NPI Registry.