NPIMap

Organization Active NPI

Woodward Detroit CVS, L.L.C.

  • Pharmacy
  • Grosse Pointe Woods, MI
National Provider Identifier
1790897635
Registry record updated Feb 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5301-005473 Issued in MI
Legal business name
WOODWARD DETROIT CVS, L.L.C.
Practice address
20460 Mack Ave
Grosse Pointe Woods, MI 48236-1659
Phone
(313) 881-2500
Fax
(313) 881-5571
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Colbert
Title
Director
Phone
(401) 765-1500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 5301-005473 MI Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

20460 Mack Ave
Grosse Pointe Woods, MI 48236-1659

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146

Other identifiers 2

IdentifierTypeStateIssuer
2347715OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2700607MedicaidMI

Other names 1

  • CVS PHARMACY #08107 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930085082 MI DME Supplier - Pharmacy 4688875149 Practice locations: Grosse Pointe Woods, MI
O20110208000865 MI Part B Supplier - Mass Immunization (Roster Biller Only) 4688875149 This NPI is an additional NPI on the enrollment

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
CVS Pharmacy #0810720460 Mack Ave, Grosse Pointe Woods, MI 48236-1659(313) 881-2500 Immunosuppressive 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|Urological Supplies|Ent… Accepts assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Woodward Detroit CVS LLC219 organizations share this tax ID, including this one

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.

View all 24

Member of 1

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

Locations

20460 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 881-2500

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1790897635",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20460 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361659",
            "telephone_number": "313-881-2500",
            "fax_number": "313-881-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODWARD DETROIT CVS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301-005473",
            "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": "2347715",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2700607",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #08107",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grosse Pointe Woods, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; 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.