Active NPI
Tennessee CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy #06429
- Pharmacy
- Lebanon, TN
National Provider Identifier
1609979319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 125
- Legal business name
- TENNESSEE CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy #06429
- Practice address
- 1228 W Main St
Lebanon, TN 37087-3208 - Phone
- (615) 444-4471
- NPI assigned
- Sep 7, 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
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 125 | TN | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1228 W Main St
Lebanon, TN 37087-3208
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4414897 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #06429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930073071 | TN | DME Supplier - Pharmacy | 3476756560 | Practice locations: Lebanon, TN |
| O20101110000381 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 3476756560 | 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 #06429 | 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
- CVS Pharmacy 04352
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1427673600000",
"number": "1609979319",
"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",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1228 W MAIN ST",
"city": "LEBANON",
"state": "TN",
"postal_code": "370873208",
"telephone_number": "615-444-4471"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TENNESSEE CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2015-03-30",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"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": "TN",
"license": "125",
"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": "4414897",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #06429",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lebanon, TN
- Jessica Mercedes Tarpley, COTA/L
- David Tawadrous
- Kelsey Brooke Taylor, RBT
- Teleoptometric Service, P.C.
- Tenn SM, LLC (Tennessee Sports Medicine & Orthopaedics)
- Tennessee Dental Professionals PC (Lebanon Dental Care)
- Tennessee Dental Professionals, PC (Cedar City Dental Care)
- Tennessee Em-I Medical Services PC
- Tennessee Maternal Fetal Medicine PLC
- Tennessee Oncology Pharmacy Dispensing
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; 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.