Active NPI
Kansas CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy # 05272
- Pharmacy
- Mission, KS
National Provider Identifier
1609970557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 2-09940
- Legal business name
- KANSAS CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy # 05272
- Practice address
- 6300 Johnson Dr
Mission, KS 66202-2611 - Phone
- (913) 722-3711
- Fax
- (913) 677-5645
- NPI assigned
- Sep 12, 2006
- 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
- Cristiana Mauricio
- Title
- MGR Phcy Enrollments
- Phone
- (401) 770-2937
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 2-09940 | KS | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
6300 Johnson Dr
Mission, KS 66202-2611
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710018 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 200602180E | Medicaid | KS |
Other names 1
- CVS PHARMACY # 05272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061002000208 | KS | Part B Supplier - Mass Immunization (Roster Biller Only) | 4082619721 | This NPI is an additional NPI on the enrollment |
| O20100930054437 | KS | DME Supplier - Pharmacy | 4082619721 | Practice locations: Mission, KS |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D2225484 | Kansas CVS Pharmacy, LLC | Certificate of waiver | May 20, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy # 05272 | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Kansas CVS Pharmacy LLC
Other organizations with this tax ID 47
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.
Locations
6300 Johnson Dr
Mission, KS 66202
Phone (913) 722-3711
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Mission, KS
- NPI 1881298966
-
- Pharmacist
- Mission, KS
- NPI 1750986741
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1412035200000",
"number": "1609970557",
"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": "6300 JOHNSON DR",
"city": "MISSION",
"state": "KS",
"postal_code": "662022611",
"telephone_number": "913-722-3711",
"fax_number": "913-677-5645"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KANSAS CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2014-09-30",
"status": "A",
"authorized_official_last_name": "MAURICIO",
"authorized_official_first_name": "CRISTIANA",
"authorized_official_title_or_position": "MGR PHCY ENROLLMENTS",
"authorized_official_telephone_number": "401-770-2937"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "KS",
"license": "2-09940",
"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": "1710018",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200602180E",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY # 05272",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mission, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.