Connecticut CVS Pharmacy LLC
Organization Active NPI Pharmacy · Hebron, CT
NPI 1598038812 · NPPES record last updated Feb 20, 2014
Key facts
- NPI
- 1598038812
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- CONNECTICUT CVS PHARMACY LLC
- Practice address
- 110 Main St
Hebron, CT 06248-1518 - Phone
- (860) 228-3888
- NPI assigned
- Feb 16, 2012
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Practitioners 4
-
Kari Burgess, RPH
-
Mary Cormier, RPH
-
Laura Landry, PHARM.D, RPH
-
Victoria Sullivan, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2224967 | Connecticut CVS Pharmacy, LLC | Certificate of waiver | May 17, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Connecticut CVS Pharmacy LLC |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101105000131 | CT | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214139633 | This NPI is an additional NPI on the enrollment |
| O20120612000098 | CT | DME Supplier - Pharmacy | 7214139633 | Practice locations: Hebron, CT |
National Provider Directory
- Tax ID family
- Connecticut CVS Pharmacy LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
110 Main St
Hebron, CT 06248-1518
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008042743 | Other | CT | DME |
| 008039579 | Medicaid | CT | |
| 0722733 | Other | NCPDP |
Other names
- CVS PHARMACY #10130
Other providers in Hebron, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.