Active NPI
Woodward Detroit CVS, L.L.C.
Doing business as CVS Pharmacy #08304
- Pharmacy
- South Lyon, MI
National Provider Identifier
1609975903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5301008020
- Legal business name
- WOODWARD DETROIT CVS, L.L.C.
- Doing business as
- CVS Pharmacy #08304
- Practice address
- 61019 Silver Lake Rd
South Lyon, MI 48178-9209 - Phone
- (248) 437-8626
- NPI assigned
- Sep 22, 2006
- Last updated
- Feb 23, 2011
- 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
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | 5301008020 | MI | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
61019 Silver Lake Rd
South Lyon, MI 48178-9209
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2366347 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #08304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930042870 | MI | DME Supplier - Pharmacy | 4688875149 | Practice locations: South Lyon, MI |
| O20110208000865 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688875149 | This NPI is an additional NPI on the enrollment |
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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #08304 | 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… | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Woodward Detroit CVS 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.
Locations
61019 Silver Lake Rd
South Lyon, MI 48178
Phone (248) 437-8626
Practitioners & affiliated clinicians
Practitioners 3
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
- South Lyon, MI
- NPI 1235761560
-
- Pharmacist
- South Lyon, MI
- NPI 1891326039
-
- Pharmacist
- South Lyon, MI
- NPI 1750912374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1298419200000",
"number": "1609975903",
"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": "61019 SILVER LAKE RD",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481789209",
"telephone_number": "248-437-8626"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WOODWARD DETROIT CVS, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-22",
"last_updated": "2011-02-23",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MI",
"license": "5301008020",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "2366347",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #08304",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in South Lyon, MI
- William a. Shortt, DDS Therese F. Shortt, DDS, PC
- Williams Therapeutic & Consulting Services LLC
- Antione J Williams, LLMSW
- Chelsea Ann Williams, M.A.
- Sikeria Ubri Williams, LPC
- Woodward Detroit CVS, L.L.C. (CVS Pharmacy #08066)
- Woodward Detroit CVS, L.L.C. (CVS Pharmacy # 01748)
- Kaitlyn Woodyard
- Lindsey Wright, SLP
- Debra Young, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; 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.