Active NPI
Holiday CVS, L.L.C.
Doing business as CVS Pharmacy # 06853
- Pharmacy
- Davenport, FL
National Provider Identifier
1659673713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- HOLIDAY CVS, L.L.C.
- Doing business as
- CVS Pharmacy # 06853
- Practice address
- 49581 US Highway 27
Davenport, FL 33897-9507 - Phone
- (863) 420-7563
- NPI assigned
- Nov 23, 2010
- Last updated
- Dec 4, 2012
- 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 | Primary | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
49581 US Highway 27
Davenport, FL 33897-9507
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003110100 | Medicaid | FL | |
| 5703029 | Other | NCPDP |
Other names 1
- CVS Pharmacy # 06853
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20110202000797 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Davenport, FL |
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 |
|---|---|---|---|
| 10D2284661 | Holiday CVS, LLC Dba CVS Pharmacy #6853 | Certificate of waiver | Jun 26, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Holiday CVS 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.
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
Practitioners 2
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
- Davenport, FL
- NPI 1538763834
-
- Pharmacist
- Davenport, FL
- NPI 1871189035
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290470400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1354579200000",
"number": "1659673713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
"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": "49581 US HIGHWAY 27",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338979507",
"telephone_number": "863-420-7563"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-23",
"last_updated": "2012-12-04",
"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": null,
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003110100",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "5703029",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy # 06853",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.