Alabama CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Sylacauga, AL
NPI 1689777302 · NPPES record last updated Feb 28, 2024
Key facts
- NPI
- 1689777302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 110903 (AL)
- Legal business name
- ALABAMA CVS PHARMACY, L.L.C.
- Practice address
- 2 N Broadway Ave
Sylacauga, AL 35150-2522 - Phone
- (256) 249-4962
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Practitioners 2
-
Heather Malone Gonsoulin, PHARM D
-
David Earl Gravette, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy # 04915 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081211000091 | AL | Part B Supplier - Mass Immunization (Roster Biller Only) | 1254492069 | |
| O20100930023475 | AL | DME Supplier - Pharmacy | 1254492069 | Practice locations: Sylacauga, AL |
National Provider Directory
- Tax ID family
- CVS Pharmacy 08363
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | AL | ||
| Pharmacy | 333600000X | 110903 | AL | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2 N Broadway Ave
Sylacauga, AL 35150-2522
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0115661 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 1689777302 | Medicaid | AL | |
| 1689777302 | Other | AL | DME |
Other names
- CVS Pharmacy #04915
Other providers in Sylacauga, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.