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Wisconsin CVS Pharmacy LLC

Organization Active NPI Pharmacy · Glendale, WI

NPI 1649947573 · NPPES record last updated Oct 7, 2021

Key facts

NPI
1649947573
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
WISCONSIN CVS PHARMACY LLC
Practice address
5701 N Lydell Ave
Glendale, WI 53217-4537
Phone
(414) 290-1973
NPI assigned
Aug 27, 2021
Organization subpart
No

Authorized official

Name
Susan F Colbert
Title
Sr Director
Phone
(401) 770-2751

Corporate family (same tax ID) 24

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.

Practitioners 138

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 138

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wisconsin CVS Pharmacy LLC
5701 N Lydell Ave, Glendale, WI 53217-4537 · (414) 290-1973		 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
Participating since Jan 1, 2023

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080110000070 WI Part B Supplier - Mass Immunization (Roster Biller Only) 1658451059 This NPI is an additional NPI on the enrollment
O20211118000965 WI DME Supplier - Pharmacy 1658451059 Practice locations: Glendale, WI

National Provider Directory

Tax ID family
Wisconsin CVS Pharmacy LLC (72 organizations share this tax ID)

Locations (25 of 47)

1485 Oneida St
#5186
Appleton, WI 54915
Phone (920) 733-1194

1485 Oneida St
Appleton, WI 54915
Phone (920) 733-1194

700 W Wisconsin Ave
Appleton, WI 54914
Phone (920) 991-1190

1717 Madison Rd
Beloit, WI 53511
Phone (608) 362-4566

1063 4th St
Beloit, WI 53511
Phone (608) 362-4566

12725 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 395-1625

17165 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 797-9074

W63N152 Washington Ave
Cedarburg, WI 53012
Phone (262) 377-5685

605 W Cottage Grove Rd
Cottage Grove, WI 53527
Phone (608) 839-3704

605 W Cottage Grove Rd
#5535
Cottage Grove, WI 53527
Phone (608) 839-3704

5740 S Packard Ave
Cudahy, WI 53110
Phone (414) 399-3665

800 Main Ave
#2214
De Pere, WI 54115
Phone (920) 336-6373

800 Main Ave
De Pere, WI 54115
Phone (920) 336-6373

2553 Sun Valley Dr
Delafield, WI 53018
Phone (262) 646-3637

5220 W Rawson Ave
Franklin, WI 53132
Phone (414) 423-5257

7800 S Lovers Lane Rd
Franklin, WI 53132
Phone (414) 448-4001

1561 W Mason St
Green Bay, WI 54303
Phone (920) 497-5959

930 Main St
#2237
Green Bay, WI 54301
Phone (920) 436-9382

2222 S Webster Ave
Green Bay, WI 54301
Phone (920) 430-8089

2050 Lime Kiln Rd
Green Bay, WI 54311
Phone (920) 406-9049

4777 S 27th St
Greenfield, WI 53221
Phone (414) 282-0634

2400 Velp Ave
Howard, WI 54303
Phone (920) 434-3954

2017 Humes Rd
Janesville, WI 53545
Phone (608) 757-0834

3710 57th Ave
#2933
Kenosha, WI 53144
Phone (262) 652-1474

2207 80th St
Kenosha, WI 53143
Phone (262) 658-3731

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

5701 N Lydell Ave
Glendale, WI 53217-4537

Mailing address

1 CVS Dr # 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other names

  • CVS PHARMACY # 17823 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 7, 2021.

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1649947573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR # 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": "5701 N LYDELL AVE",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174537",
            "telephone_number": "414-290-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY # 17823",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS PHARMACY # 17823",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, WI

All providers in Glendale, WI · Pharmacy in Wisconsin

Sources for this page

Verify at the official NPI Registry.