Active NPI
Tennessee CVS Pharmacy LLC
Doing business as CVS Pharmacy #05664
- Pharmacy
- Kingsport, TN
National Provider Identifier
1871696583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 1417
- Legal business name
- TENNESSEE CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #05664
- Practice address
- 4106 Fort Henry Dr
Kingsport, TN 37663-2226 - Phone
- (423) 239-5118
- NPI assigned
- Sep 7, 2006
- Last updated
- Sep 16, 2011
- 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
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 1417 | TN | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4106 Fort Henry Dr
Kingsport, TN 37663-2226
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4419164 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY #05664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101110000381 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 3476756560 | This NPI is an additional NPI on the enrollment |
| O20110706000044 | TN | DME Supplier - Pharmacy | 3476756560 | Practice locations: Kingsport, TN |
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 #05664 | 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
- Tennessee 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.
-
dba Target Pharmacy
- Community/Retail Pharmacy
- Knoxville, TN
- NPI 1811939002
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": "1316131200000",
"number": "1871696583",
"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": "4106 FORT HENRY DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376632226",
"telephone_number": "423-239-5118"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TENNESSEE CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2011-09-16",
"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": "TN",
"license": "1417",
"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": "4419164",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #05664",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kingsport, TN
- Tennessee Anesthesiology LLC
- Tennessee Cancer Specialist PLLC
- Tennessee CVS Pharmacy LLC (CVS Pharmacy #04130)
- Tennessee CVS Pharmacy LLC (CVS Pharmacy #17398)
- Tennessee CVS Pharmacy LLC (CVS Pharmacy #04240)
- Tennessee Nursing Services of Morristown, Inc. (Beacon Home Health)
- Tennessee Physical Therapy Services of Kingsport, LLC (Tennessee Physical Therapy Services of Kingsport)
- Brittney R Terry, DO
- George M Testerman Jr., MD
- The Beauty Studio Medical Aesthetics (The Beauty Studio)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.