Active NPI
Maryland CVS Pharmacy LLC
Doing business as CVS Pharmacy 04017
- Pharmacy
- Pasadena, MD
National Provider Identifier
1861595381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- P01023
- Legal business name
- MARYLAND CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy 04017
- Practice address
- 28 Magothy Beach Rd
Pasadena, MD 21122-4428 - Phone
- (410) 437-6450
- NPI assigned
- Sep 7, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | P01023 | MD | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
28 Magothy Beach Rd
Pasadena, MD 21122-4428
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2112376 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| P00754543 | Other | MEDICARE RR |
Other names 1
- CVS PHARMACY 04017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090916000218 | MD | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719033703 | This NPI is an additional NPI on the enrollment |
| O20110721000697 | MD | DME Supplier - Pharmacy | 7719033703 | Practice locations: Pasadena, MD |
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 #04017 | 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… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Maryland 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.
-
- Community/Retail Pharmacy
- Upper Marlboro, MD
- NPI 1821549056
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": "1322179200000",
"number": "1861595381",
"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",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 MAGOTHY BEACH RD",
"city": "PASADENA",
"state": "MD",
"postal_code": "211224428",
"telephone_number": "410-437-6450"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARYLAND CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2011-11-25",
"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": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MD",
"license": "P01023",
"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": "2112376",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "P00754543",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 04017",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pasadena, MD
- Marta Markman MD & Assoc PA
- Gail Louise Martin, LCSW-C
- Michelle Lee Martin
- Martins Love and Care Alh LLC
- Maryland CVS Pharmacy LLC (CVS Pharmacy 04418)
- Maryland Dental Associates LLC (Pasadena Dental Associates)
- Maryland Primary Care Physicians, LLC
- Maryland Sports, Spine and Musculoskeletal Institute (Mssmi)
- Maryland Sportscare & Rehab LLC
- Megan Kelley Mathias, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.