Active NPI
Wisconsin CVS Pharmacy LLC
Doing business as CVS Pharmacy
- Pharmacy
- Cedarburg, WI
National Provider Identifier
1528009495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- WISCONSIN CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy
- Practice address
- W63N152 Washington Ave
Cedarburg, WI 53012-2725 - Phone
- (262) 377-6090
- NPI assigned
- Jun 9, 2006
- Last updated
- Mar 2, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Director Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
W63N152 Washington Ave
Cedarburg, WI 53012-2725
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5129083 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080110000070 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 1658451059 | |
| O20100930003787 | WI | DME Supplier - Pharmacy | 1658451059 | Practice locations: Cedarburg, WI |
National Provider Directory
National Provider Directory- Tax ID family
- Wisconsin CVS Pharmacy LLC
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Pharmacist
- Cedarburg, WI
- NPI 1316574841
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1330646400000",
"number": "1528009495",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W63N152 WASHINGTON AVE",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530122725",
"telephone_number": "262-377-6090"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WISCONSIN CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-09",
"last_updated": "2012-03-02",
"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": "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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "5129083",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cedarburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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.