NPIMap

Organization Active NPI

Maryland CVS Pharmacy, L.L.C.

  • Pharmacy
  • Wheaton, MD
National Provider Identifier
1548356850
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
P04473 Issued in MD
Legal business name
MARYLAND CVS PHARMACY, L.L.C.
Doing business as
CVS Pharmacy #01177
Practice address
11190 Viers Mill Road
Wheaton, MD 20902
Phone
(301) 942-1791
Fax
(401) 770-7108
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X P04473 MD Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

11190 Viers Mill Road
Wheaton, MD 20902

Mailing address

1 CVS Drive
Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895-7243
Phone (401) 766-1500

Other identifiers 1

IdentifierTypeStateIssuer
6611079 00MedicaidMD

Other names 1

  • CVS Pharmacy #01177 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090928000399 DC Part B Supplier - Mass Immunization (Roster Biller Only) 7719033703 This NPI is an additional NPI on the enrollment
O20100930068005 MD DME Supplier - Pharmacy 7719033703 Practice locations: Wheaton, MD

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2283809Maryland CVS Pharmacy LLC Dba CVS/Pharmacy #0117711190 Viers Mill Road, Wheaton, MD 20902Certificate of waiverJun 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
CVS Health192 organizations share this tax ID, including this one

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.

View all 24

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1548356850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DRIVE",
            "address_2": "BOX 1075-PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028957243",
            "telephone_number": "401-766-1500",
            "fax_number": "401-770-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11190 VIERS MILL ROAD",
            "city": "WHEATON",
            "state": "MD",
            "postal_code": "20902",
            "telephone_number": "301-942-1791",
            "fax_number": "401-770-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2010-11-10",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "P04473",
            "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": "6611079 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #01177",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheaton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.