Ohio CVS Stores LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

2093800 Issued in OH

Legal business name

OHIO CVS STORES LLC

Practice address

212 W Bagley Rd
Berea, OH 44017-1830

Phone

(440) 243-6676

NPI assigned

Sep 7, 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

Director

Phone

(401) 765-1500

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• CVS PHARMACY #03035 Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

Locations

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319500800000",
    "number": "1811090533",
    "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": "212 W BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171830",
            "telephone_number": "440-243-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO CVS STORES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2011-10-25",
        "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": "OH",
            "license": "2093800",
            "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": "3610258",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #03035",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Norris
• North Shore Placement Services
• North Shore Residential Services
• Northeast Care Center, Inc.
• Erika O'Grady
• Ohioguidestone
• Ohioguidestone
• Ohioguidestone
• Ohioguidestone
• Ohioguidestone

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.