Active NPI
Maryland CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy # 01484
- Pharmacy
- Frederick, MD
National Provider Identifier
1669576591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- P00541
- Legal business name
- MARYLAND CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy # 01484
- Practice address
- 402 S Jefferson St
Frederick, MD 21701-6208 - Phone
- (301) 663-4861
- NPI assigned
- Sep 12, 2006
- Last updated
- Mar 23, 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 Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | P00541 | MD | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
402 S Jefferson St
Frederick, MD 21701-6208
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2100927 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 3621171 00 | Medicaid | MD |
Other names 1
- CVS PHARMACY # 01484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090916000218 | MD | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719033703 | This NPI is an additional NPI on the enrollment |
| O20100930049038 | MD | DME Supplier - Pharmacy | 7719033703 | Practice locations: Frederick, MD |
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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #01484 | 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… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Maryland CVS Pharmacy 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1332460800000",
"number": "1669576591",
"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",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 S JEFFERSON ST",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217016208",
"telephone_number": "301-663-4861"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARYLAND CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2012-03-23",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MD",
"license": "P00541",
"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": "2100927",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3621171 00",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY # 01484",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Frederick, MD
- Maryland CVS Pharmacy LLC (CVS Pharmacy # 10203)
- Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 01437)
- Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 01518)
- Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 02230)
- Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 02335)
- Maryland Dental Affiliates, P.C. (Frederick Perio & Implants)
- Maryland Family Care, Inc.
- Maryland Family Health Services, LLC
- Maryland Grocery Store Company (Giant Eagle Pharmacy 1841)
- Maryland Grocery Store Company (Giant Eagle Pharmacy 1842)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.