NPIMap

Organization Active NPI

Pennsylvania CVS Pharmacy, L.L.C.

Doing business as CVS Pharmacy #01688

  • Pharmacy
  • State College, PA
National Provider Identifier
1598866055
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PP411825L Issued in PA
Legal business name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Doing business as
CVS Pharmacy #01688
Practice address
1630 S Atherton St
State College, PA 16801-6209
Phone
(814) 237-1479
NPI assigned
Sep 26, 2006
Last updated
Sep 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

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 PP411825L PA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1630 S Atherton St
State College, PA 16801-6209

Mailing address

1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146

Other identifiers 1

IdentifierTypeStateIssuer
3902574OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • CVS PHARMACY #01688 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080116000450 PA Part B Supplier - Mass Immunization (Roster Biller Only) 8527149566 This NPI is an additional NPI on the enrollment
O20100930011377 PA DME Supplier - Pharmacy 8527149566 Practice locations: State College, PA

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
39D2259107CVS/Pharmacy #016881630 South Atherton St, State College, PA 16801Certificate of waiverMay 1, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #016881630 S Atherton St, State College, PA 16801-6209(814) 237-1479 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 Dec 27, 2024

National Provider Directory

National Provider Directory
Tax ID family
Pennsylvania CVS Pharmacy LLC431 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.

Locations

404 N Logan Blvd
#1687
Burnham, PA 17009
Phone (717) 248-3991

765 S West St
Carlisle, PA 17013
Phone (717) 243-1384

1630 S Atherton St
State College, PA 16801
Phone (814) 237-1479

2080 S Queen St
#1657
York, PA 17403
Phone (717) 845-1633

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1598866055",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 S ATHERTON ST",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168016209",
            "telephone_number": "814-237-1479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2014-09-12",
        "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": "PA",
            "license": "PP411825L",
            "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": "3902574",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #01688",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.