Active NPI
Garfield Beach CVS LLC
Doing business as CVS Pharmacy #10478
- Pharmacy
- Crescent City, CA
National Provider Identifier
1679019319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- GARFIELD BEACH CVS LLC
- Doing business as
- CVS Pharmacy #10478
- Practice address
- 657 Hwy 101 N
Crescent City, CA 95531 - Phone
- (707) 464-5429
- NPI assigned
- Jan 18, 2017
- Last updated
- Jun 14, 2017
- 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
- Sr Dir Payer Relations
- Phone
- (401) 765-2751
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
657 Hwy 101 N
Crescent City, CA 95531
Mailing address
1 CVS Dr
Box 1075 -Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5541620751 | Other | CA | MEDICARE NSC |
| 5662033 | Other | NCPDP |
Other names 1
- CVS Pharmacy #10478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080117000218 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5799866620 | This NPI is an additional NPI on the enrollment |
| O20170601000444 | CA | DME Supplier - Pharmacy | 5799866620 | Practice locations: Crescent City, CA |
National Provider Directory
National Provider Directory- Tax ID family
- CVS Pharmacy 09578
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": "1484697600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1497398400000",
"number": "1679019319",
"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",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "657 HWY 101 N",
"city": "CRESCENT CITY",
"state": "CA",
"postal_code": "95531",
"telephone_number": "707-464-5429"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GARFIELD BEACH CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-01-18",
"last_updated": "2017-06-14",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR DIR PAYER RELATIONS",
"authorized_official_telephone_number": "401-765-2751"
},
"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": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NSC",
"identifier": "5541620751",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "5662033",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #10478",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Crescent City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.