Ohio CVS Stores LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

OHIO CVS STORES LLC

Practice address

2205 Walker Lake Rd
Ontario, OH 44903-6519

Phone

(419) 747-1450

Fax

(419) 747-1450

NPI assigned

Jul 24, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• CVS Pharmacy #16720 Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Member of 1

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

• CVS Pharmacy Inc

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478131200000",
    "number": "1730101445",
    "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": "2205 WALKER LAKE RD",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449036519",
            "telephone_number": "419-747-1450",
            "fax_number": "419-747-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO CVS STORES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2016-11-03",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "RTPC.022571100-03",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2078402",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #16720",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Nirmalnath, M.D.
• Savana Paige Nossa, RN
• Candy Jo O'Dell
• Kimberly S Obringer, AUD
• Ohio CVS Stores LLC
• Ohio Dental Professionals Workman, PC
• Ohio District 5 Area Agency on Aging
• Ohio Eye Optometric, LLC
• Ohio Health Partners LLC
• Ontario Family Medicine

• Pharmacy in Ontario, OH
• Providers in Ontario, OH by specialty
• Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.