NPIMap

Arizona CVS Stores LLC

Organization Active NPI Pharmacy · Phoenix, AZ

NPI 1821039876 · NPPES record last updated Dec 23, 2014

Key facts

NPI
1821039876
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
ARIZONA CVS STORES LLC
Practice address
21001 N Tatum Blvd
Phoenix, AZ 85050-4240
Phone
(480) 419-3921
NPI assigned
Jun 9, 2006
Organization subpart
No

Authorized official

Name
Susan F Colbert
Title
Director Pharmacy Enrollments
Phone
(401) 770-2751

Corporate family (same tax ID) 24

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

Member of 1

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

Practitioners 2

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2218863Arizona CVS Stores, LLC
21001 N Tatum Blvd Ste 82, Phoenix, AZ 85050		Certificate of waiverMar 30, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #09339
21001 N Tatum Blvd, Phoenix, AZ 85050-4240 · (480) 419-3921		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AZ

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100107000345 AZ Part B Supplier - Mass Immunization (Roster Biller Only) 6406997899 This NPI is an additional NPI on the enrollment
O20100930058919 AZ DME Supplier - Pharmacy 6406997899 Practice locations: Phoenix, AZ

National Provider Directory

Tax ID family
Cvspharmacy 9293 (64 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

21001 N Tatum Blvd
Phoenix, AZ 85050-4240

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
0354148OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY 09339 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 23, 2014.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419292800000",
    "number": "1821039876",
    "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": "21001 N TATUM BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504240",
            "telephone_number": "480-419-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA CVS STORES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2014-12-23",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR PHARMACY ENROLLMENTS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "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": "0354148",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY 09339",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

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Sources for this page

Verify at the official NPI Registry.