Active NPI
New Jersey CVS Pharmacy LLC
Doing business as CVS Pharmacy #06075
- Pharmacy
- Stanhope, NJ
National Provider Identifier
1659474476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 4824
- Legal business name
- NEW JERSEY CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #06075
- Practice address
- 77 Route 206
Stanhope, NJ 07874 - Phone
- (973) 426-0466
- NPI assigned
- Sep 7, 2006
- Last updated
- Oct 10, 2016
- 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, Contract Administration
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | 4824 | NJ | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
77 Route 206
Stanhope, NJ 07874
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3134448 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 0235989 | Medicaid | NJ |
Other names 1
- CVS PHARMACY #06075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100830000881 | NJ | Part B Supplier - Mass Immunization (Roster Biller Only) | 2365566288 | This NPI is an additional NPI on the enrollment |
| O20100930086826 | NJ | DME Supplier - Pharmacy | 3678777851 | Practice locations: Stanhope, NJ |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2282362 | New Jersey CVS Pharmacy LLC | Certificate of waiver | May 18, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- New Jersey CVS Pharm 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.
Practitioners & affiliated clinicians
Practitioners 1
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 Clinician (PhC)/ Clinical Pharmacy Specialist
- Stanhope, NJ
- NPI 1902401284
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": "1476057600000",
"number": "1659474476",
"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": "77 ROUTE 206",
"city": "STANHOPE",
"state": "NJ",
"postal_code": "07874",
"telephone_number": "973-426-0466"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEW JERSEY CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2016-10-10",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F.",
"authorized_official_title_or_position": "DIRECTOR, CONTRACT ADMINISTRATION",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NJ",
"license": "4824",
"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": "3134448",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0235989",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #06075",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Stanhope, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.