NPIMap

Arkansas CVS Pharmacy, L.L.C.

Organization Active NPI Pharmacy · Jonesboro, AR

NPI 1700334455 · NPPES record last updated Dec 27, 2016

Key facts

NPI
1700334455
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
ARKANSAS CVS PHARMACY, L.L.C.
Practice address
110 Southwest Drive
Jonesboro, AR 72401-5827
Phone
(870) 268-1743
NPI assigned
Sep 12, 2016
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Sr. Director-Payer Relations
Phone
(401) 765-1500

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 22

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2216513CVS/Pharmacy #10666
110 Southwest Dr, Jonesboro, AR 72401		Certificate of waiverMar 11, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #10666
110 Southwest Dr, Jonesboro, AR 72401-5827 · (870) 268-1743		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130123000342 AR Part B Supplier - Mass Immunization (Roster Biller Only) 9436301546 24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Little Rock, AR; North Little Rock, AR; Paragould, AR; Pringdale, AR; Rogers, AR; Russellville, AR; Sherwood, AR; Texarkana, AR…
O20161218000000 AR DME Supplier - Pharmacy 9436301546 Practice locations: Jonesboro, AR

National Provider Directory

Tax ID family
Arkansas CVS Pharmacy LLC (23 organizations share this tax ID)

Locations

110 Southwest Dr
Jonesboro, AR 72401
Phone (870) 268-1743

Specialties & licenses

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

Addresses

Primary practice location

110 Southwest Drive
Jonesboro, AR 72401-5827

Mailing address

One CVS Drive
Mail Code 1090
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
216258407MedicaidAR
0425757OtherARNCPDP

Other names

  • CVS PHARMACY # 10666 Doing business as

Other providers in Jonesboro, AR

All providers in Jonesboro, AR · Pharmacy in Arkansas

Sources for this page

Verify at the official NPI Registry.