NPIMap

Organization Active NPI

Wisconsin CVS Pharmacy LLC

Doing business as CVS Pharmacy # 17823

  • Pharmacy
  • Glendale, WI
National Provider Identifier
1649947573
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
WISCONSIN CVS PHARMACY LLC
Doing business as
CVS Pharmacy # 17823
Practice address
5701 N Lydell Ave
Glendale, WI 53217-4537
Phone
(414) 290-1973
NPI assigned
Aug 27, 2021
Last updated
Oct 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary
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 1

  • CVS PHARMACY # 17823 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wisconsin CVS Pharmacy LLC5701 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 assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin CVS Pharmacy LLC72 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 (25 of 39)

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

1800 W College Ave
Appleton, WI 54914
Phone (920) 991-1190

535 E Division Ave
Barron, WI 54812
Phone (715) 637-0991

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

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

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

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

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

3915 Durand Ave
Elmwood Park, WI 53405
Phone (262) 554-0035

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

5701 N Lydell Ave
Glendale, WI 53217
Phone (414) 290-1973

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

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

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

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

1700 Milton Ave
Janesville, WI 53545
Phone (608) 756-0614

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

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

3726 22nd Ave
Kenosha, WI 53140
Phone (262) 654-6545

4301 Lien Rd
Madison, WI 53704
Phone (608) 327-5382

6701 Mineral Point Rd
#7147
Madison, WI 53705
Phone (608) 833-4588

701 E Reed Ave
Manitowoc, WI 54220
Phone (920) 682-3726

N83W15550 Appleton Ave
#4996
Menomonee Falls, WI 53051
Phone (262) 253-5056

6210 Century Ave
Middleton, WI 53562
Phone (608) 836-6630

Practitioners & affiliated clinicians

Practitioners 140

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.

View all 140

NPI Registry JSON

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

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.