Active NPI
New Jersey CVS Pharmacy LLC
Doing business as CVS Pharmacy #11012
- Pharmacy
- Middletown, NJ
National Provider Identifier
1821652611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- NEW JERSEY CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #11012
- Practice address
- 1200 Highway 35
Middletown, NJ 07748-2013 - Phone
- (732) 320-4568
- NPI assigned
- Apr 26, 2019
- Last updated
- May 31, 2019
- 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 F Colbert
- Title
- Sr. Director
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1200 Highway 35
Middletown, NJ 07748-2013
Mailing address
1 CVS Dr # 1075
Woonsocket, RI 02895-6146
Other names 1
- CVS Pharmacy #11012
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100830000881 | NJ | Part B Supplier - Mass Immunization (Roster Biller Only) | 2365566288 | This NPI is an additional NPI on the enrollment |
| O20190807000914 | NJ | DME Supplier - Pharmacy | 3678777851 | Practice locations: Middletown, NJ |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2282352 | New Jersey CVS Pharmacy LLC | Certificate of waiver | May 18, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #11012 | 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
- New Jersey 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.
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Pharmacist
- Middletown, NJ
- NPI 1245872472
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Middletown, NJ
- NPI 1417550534
-
- Pharmacist
- Middletown, NJ
- NPI 1144823279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1559260800000",
"number": "1821652611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR # 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 HIGHWAY 35",
"city": "MIDDLETOWN",
"state": "NJ",
"postal_code": "077482013",
"telephone_number": "732-320-4568"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEW JERSEY CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-04-26",
"last_updated": "2019-05-31",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "SR. DIRECTOR",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"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": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #11012",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CVS Pharmacy #11012",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Middletown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; 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.