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New Jersey CVS Pharmacy LLC

Organization Active NPI Pharmacy · Tinton Falls, NJ

NPI 1659463255 · NPPES record last updated Nov 5, 2010

Key facts

NPI
1659463255
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
RS00621800 (NJ)
Legal business name
NEW JERSEY CVS PHARMACY LLC
Practice address
4000 State Route 66
Tinton Falls, NJ 07753-7300
Phone
(732) 922-7950
NPI assigned
Sep 29, 2006
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Director
Phone
(401) 765-1500

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.

Medicare participation

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

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100830000881 NJ Part B Supplier - Mass Immunization (Roster Biller Only) 2365566288 This NPI is an additional NPI on the enrollment
O20100930056207 NJ DME Supplier - Pharmacy 3678777851 Practice locations: Tinton Falls, NJ

National Provider Directory

Tax ID family
New Jersey CVS Pharmacy LLC (336 organizations share this tax ID)

Locations

4000 State Route 66
Tinton Falls, NJ 07753
Phone (732) 922-7950

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X RS00621800 NJ Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4000 State Route 66
Tinton Falls, NJ 07753-7300

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146

Other identifiers

IdentifierTypeStateIssuer
3144932OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY 02868 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 Nov 5, 2010.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1659463255",
    "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": "4000 STATE ROUTE 66",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077537300",
            "telephone_number": "732-922-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2010-11-05",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "RS00621800",
            "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": "3144932",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY 02868",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tinton Falls, NJ

All providers in Tinton Falls, NJ · Pharmacy in New Jersey

Sources for this page

Verify at the official NPI Registry.