NPIMap

Organization Active NPI

Oklahoma CVS Pharmacy LLC

Doing business as CVS Pharmacy #08279

  • Pharmacy
  • Broken Arrow, OK
National Provider Identifier
1679804934
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
OKLAHOMA CVS PHARMACY LLC
Doing business as
CVS Pharmacy #08279
Practice address
2351 N 9TH St
Broken Arrow, OK 74012
Phone
(918) 355-1293
Fax
(918) 355-1361
NPI assigned
Jan 26, 2010
Last updated
Oct 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan F Colbert
Title
Director, Managed Care Admin
Phone
(401) 770-2751

Specialties & licenses 3

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

Addresses

Primary practice location

2351 N 9TH St
Broken Arrow, OK 74012

Mailing address

One CVS Drive
Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895
Phone (401) 765-1500

Other identifiers 3

IdentifierTypeStateIssuer
3726051OtherNCPDP
200113030JOtherOKMEDICAID DME
200113030KMedicaidOK

Other names 1

  • CVS Pharmacy #08279 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100903000320 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1759405350 This NPI is an additional NPI on the enrollment
O20100930036598 OK DME Supplier - Pharmacy 1759405350 Practice locations: Broken Arrow, OK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2224401CVS/Pharmacy #082792351 N 9TH St, Broken Arrow, OK 74012Certificate of waiverMay 12, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #082792351 N 9TH St, Broken Arrow, OK 74012-2850(918) 355-1293 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 assignmentParticipating since Jan 1, 2025

National Provider Directory

National Provider Directory
Tax ID family
Oklahoma CVS Pharmacy LLC60 organizations share this tax ID, including this one

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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2351 N 9th St
Broken Arrow, OK 74012
Phone (918) 355-1293

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1679804934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CVS DRIVE",
            "address_2": "BOX 1075-PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "02895",
            "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": "2351 N 9TH ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-355-1293",
            "fax_number": "918-355-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2013-10-31",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR, MANAGED CARE ADMIN",
        "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": "NU",
            "license": null,
            "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": "NCPDP",
            "identifier": "3726051",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "200113030J",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200113030K",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #08279",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; 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.

Verify at the official NPI Registry.