Active NPI
Georgia CVS Pharmacy LLC
Doing business as CVS Pharmacy # 04507
- Pharmacy
- Gainesville, GA
National Provider Identifier
1780787200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 004074
- Legal business name
- GEORGIA CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy # 04507
- Practice address
- 103 Jesse Jewel Pkwy SW
Gainesville, GA 30501-4321 - Phone
- (770) 536-3441
- NPI assigned
- Sep 7, 2006
- Last updated
- Apr 21, 2022
- 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
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 004074 | GA | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
103 Jesse Jewel Pkwy SW
Gainesville, GA 30501-4321
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1101310 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY # 04507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000543 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8123161429 | This NPI is an additional NPI on the enrollment |
| O20110517000470 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Gainesville, GA |
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 #04507 | 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
- Ga 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": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1650499200000",
"number": "1780787200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO 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": "103 JESSE JEWEL PKWY SW",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305014321",
"telephone_number": "770-536-3441"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGIA CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2022-04-21",
"certification_date": "2022-04-21",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "GA",
"license": "004074",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1101310",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY # 04507",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS PHARMACY # 04507",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gainesville, GA
- Kevin Daniel Gentner
- Lindsay Spradley Gentry, LCSW
- Zachary Hale George, M.D.
- Georgia CVS Pharmacy L.L.C. (CVS Pharmacy #05071)
- Georgia CVS Pharmacy LLC (CVS Pharmacy # 05626)
- Georgia Dental Group of Ga LLC (Elite Dentistry of Georgia)
- Georgia Dental Professionals, PC
- Georgia Dental Professionals, PC (Green Street Smiles)
- Georgia Dept of Human Resouces Field Fiscal Services - Region II
- Georgia Developmental Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; 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.