NPIMap

CVS Pharmacy Inc

Organization Active NPI Pharmacy · Odessa, TX

NPI 1710466610 · NPPES record last updated Oct 31, 2018

Key facts

NPI
1710466610
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
CVS PHARMACY INC
Practice address
3050 W University Blvd
Odessa, TX 79764
Phone
(432) 332-8470
NPI assigned
Aug 10, 2018
Organization subpart
No

Authorized official

Name
Susan F Colbert
Title
Sr Director
Phone
(401) 770-2751

Corporate family (same tax ID) 24

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

Practitioners 1

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
45D2185580CVS Pharmacy Inc Dba CVS/Pharmacy # 11099
3050 W. University Blvd, Odessa, TX 79764		Certificate of waiverJun 3, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy # 11099
3050 W University Blvd, Odessa, TX 79764-7129 · (401) 765-1500		 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 Mar 12, 2025

Medicare participation

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

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090408000170 TX Part B Supplier - Mass Immunization (Roster Biller Only) 5092711895 This NPI is an additional NPI on the enrollment
O20181119000672 TX DME Supplier - Pharmacy 5092711895 Practice locations: Odessa, TX

National Provider Directory

Tax ID family
CVS Pharmacy Inc Agent for CVS RX Services Inc (1,253 organizations share this tax ID)

Locations

3050 W University Blvd
Odessa, TX 79764
Phone (432) 332-8470

Specialties & licenses

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

Addresses

Primary practice location

3050 W University Blvd
Odessa, TX 79764

Mailing address

1 CVS Dr # 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other names

  • CVS PHARMACY # 11099 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 31, 2018.

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540944000000",
    "number": "1710466610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR # 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": "3050 W UNIVERSITY BLVD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "79764",
            "telephone_number": "432-332-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CVS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2018-10-31",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY # 11099",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS PHARMACY # 11099",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odessa, TX

All providers in Odessa, TX · Pharmacy in Texas

Sources for this page

Verify at the official NPI Registry.