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Holiday CVS LLC

Organization Active NPI Pharmacy · Miramar Beach, FL

NPI 1861596785 · NPPES record last updated Sep 11, 2015

Key facts

NPI
1861596785
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
20413 (FL)
Legal business name
HOLIDAY CVS LLC
Practice address
130 Scenic Gulf Dr
Miramar Beach, FL 32550-4960
Phone
(850) 837-3999
Fax
(850) 837-3605
NPI assigned
Sep 12, 2006
Organization subpart
No

Authorized official

Name
Susan F Colbert
Title
Director,Payer Relations
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.

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 3

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
10D2227368Holiday CVS LLC Dba CVS/Pharmacy #3684
130 Scenic Gulf Drive, Miramar Beach, FL 32550		Certificate of waiverJun 10, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Holiday CVS LLC
130 Scenic Gulf Drive, Miramar Beach, FL 32550-4036 · (850) 837-3999		 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 FL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081223000620 FL Part B Supplier - Mass Immunization (Roster Biller Only) 2668534702 This NPI is an additional NPI on the enrollment
O20100930009680 FL DME Supplier - Pharmacy 2668534702 Practice locations: Miramar Beach, FL

National Provider Directory

Tax ID family
Holiday CVS LLC (738 organizations share this tax ID)

Locations

35 Poinciana Blvd
Destin, FL 32550
Phone (850) 837-3999

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 20413 FL Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

130 Scenic Gulf Dr
Miramar Beach, FL 32550-4960

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
1050955OtherOTHER ID NUMBER-COMMERCIAL NUMBER
105773100MedicaidFL

Other names

  • CVS PHARMACY 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 Sep 11, 2015.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441929600000",
    "number": "1861596785",
    "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": "130 SCENIC GULF DR",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325504960",
            "telephone_number": "850-837-3999",
            "fax_number": "850-837-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLIDAY CVS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2015-09-11",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "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": "FL",
            "license": "20413",
            "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": "1050955",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105773100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miramar Beach, FL

All providers in Miramar Beach, FL · Pharmacy in Florida

Sources for this page

Verify at the official NPI Registry.