Active NPI
Oklahoma CVS Pharmacy LLC
Doing business as CVS Pharmacy #17513
- Pharmacy
- Yukon, OK
National Provider Identifier
1700034709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- OKLAHOMA CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #17513
- Practice address
- 1700 Garth Brooks Blvd
Yukon, OK 73099-6387 - Phone
- (405) 494-3180
- Fax
- (405) 494-3185
- NPI assigned
- Sep 3, 2008
- Last updated
- Nov 8, 2016
- 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. 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 | NU | Primary | |
| Community/Retail Pharmacy | 3336C0003X | 26-7625 | OK |
Addresses
Primary practice location
1700 Garth Brooks Blvd
Yukon, OK 73099-6387
Mailing address
1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2116804 | Other | PK |
Other names 1
- CVS Pharmacy #17513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100903000320 | OK | Part B Supplier - Mass Immunization (Roster Biller Only) | 1759405350 | This NPI is an additional NPI on the enrollment |
| O20161001000003 | OK | DME Supplier - Pharmacy | 1759405350 | Practice locations: Yukon, OK |
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 #17513 | 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
- Oklahoma 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": "1220400000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1478563200000",
"number": "1700034709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075",
"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": "1700 GARTH BROOKS BLVD",
"city": "YUKON",
"state": "OK",
"postal_code": "730996387",
"telephone_number": "405-494-3180",
"fax_number": "405-494-3185"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OKLAHOMA CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-09-03",
"last_updated": "2016-11-08",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. 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": "NU",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "OK",
"license": "26-7625",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2116804",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #17513",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Yukon, OK
- Ok Specialty Dental Services, PLLC (Red Dirt Orthodontics)
- Ok Specialty Smiles, PLLC
- Oklahoma City Vamc
- Oklahoma Counseling Group by M & M, LLC (Oklahoma Counseling Group)
- Oklahoma CVS Pharmacy LLC (CVS Pharmacy #08312)
- Oklahoma Dental
- Oklahoma Dental-Yukon
- Oklahoma Eye Specialist PLLC
- Oklahoma Family Counseling
- Oklahoma Family Counseling Centers
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; 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.