NPIMap

Organization Active NPI

Mississippi CVS Pharmacy LLC

Doing business as CVS Pharmacy #17144

  • Pharmacy
  • Hattiesburg, MS
National Provider Identifier
1760404453
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MISSISSIPPI CVS PHARMACY LLC
Doing business as
CVS Pharmacy #17144
Practice address
6143 U S Highway 98 Ste 80
Hattiesburg, MS 39402-4405
Phone
(601) 296-9245
Fax
(601) 296-9245
NPI assigned
Jul 24, 2006
Last updated
Nov 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU Primary
Community/Retail Pharmacy 3336C0003X 06754/1.2 MS

Addresses

Primary practice location

6143 U S Highway 98 Ste 80
Hattiesburg, MS 39402-4405

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2047233OtherPK

Other names 1

  • CVS Pharmacy #17144 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101230001038 MS Part B Supplier - Mass Immunization (Roster Biller Only) 9335344456 Practice locations: Picayune, MS; Pascagoula, MS; Oxford, MS; Olive Branch, MS; Ocean Springs, MS; Natchez, MS; Laurel, MS; Meridian, MS…
O20160921000502 MS DME Supplier - Pharmacy 9335344456 Practice locations: Hattiesburg, MS

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Mississippi CVS Pharmacy LLC6143 U S Highway 98, Hattiesburg, MS 39402-4405(601) 296-9245 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 assignmentParticipating since Jan 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Mississippi CVS Pharmacy LLC48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Member of 1

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

Locations (25 of 85)

301 American Ave
Booneville, MS 38829
Phone (662) 720-1707

112 Stribling Ln
#5865
Brandon, MS 39042

801 Highway 80 E
Clinton, MS 39056
Phone (601) 924-2111

801 Highway 80 E
#10020
Clinton, MS 39056
Phone (301) 924-2111

4422 Kalani Dr
Diamondhead, MS 39525
Phone (228) 255-7343

4422 Kalani Dr
#10755
Diamondhead, MS 39525
Phone (228) 255-7346

12024 Lamey Bridge Rd
Diberville, MS 39540
Phone (228) 380-3533

12024 Lamey Bridge Rd
#47
Diberville, MS 39540
Phone (228) 396-2858

3867 Promenade Pkwy
Diberville, MS 39540
Phone (228) 233-3302

3867 Promenade Pkwy
#17532
Diberville, MS 39540
Phone (228) 233-3302

170 Promenade Blvd
#17038
Flowood, MS 39232
Phone (601) 992-0676

4899 Lakeland Dr
#8311
Flowood, MS 39232
Phone (601) 919-3044

822 Highway 35 N
Forest, MS 39074
Phone (601) 469-1540

822 Highway 35 N
#5846
Forest, MS 39074
Phone (601) 469-1540

212 W Park Ave
#5801
Greenwood, MS 38930
Phone (662) 453-8505

1209 Sunset Dr
#4376
Grenada, MS 38901
Phone (662) 294-0665

11022 Highway 49
Gulfport, MS 39503
Phone (228) 832-8981

11022 Highway 49
#5908
Gulfport, MS 39503
Phone (228) 865-8981

1422 E Pass Rd
Gulfport, MS 39507
Phone (228) 604-0138

1422 E Pass Rd
#5933
Gulfport, MS 39507
Phone (228) 604-0138

2424 25th Ave
Gulfport, MS 39501
Phone (228) 822-0163

2424 25th Ave
#5923
Gulfport, MS 39501
Phone (228) 822-0163

2507 Hardy St
#3124
Hattiesburg, MS 39401
Phone (601) 544-2545

3910 Hardy St
#5744
Hattiesburg, MS 39402
Phone (601) 264-6300

6143 U S Highway 98
Ste 80
Hattiesburg, MS 39402
Phone (601) 296-9245

Practitioners & affiliated clinicians

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1760404453",
    "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": "6143 U S HIGHWAY 98 STE 80",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394024405",
            "telephone_number": "601-296-9245",
            "fax_number": "601-296-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2016-11-04",
        "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": "MS",
            "license": "06754/1.2",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047233",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #17144",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.

Verify at the official NPI Registry.