CVS Pharmacy Inc
Organization Active NPI Pharmacy · Fort Worth, TX
NPI 1881798684 · NPPES record last updated Mar 25, 2015
Key facts
- NPI
- 1881798684
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 24849 (TX)
- Legal business name
- CVS PHARMACY INC
- Practice address
- 5012 Trail Lake Dr
Fort Worth, TX 76133-2028 - Phone
- (817) 292-1700
- Fax
- (817) 292-8246
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Practitioners 3
-
Robert Matthew Boulware, PHARM.D.
-
Thang Duc Nguyen, PHARMD
-
Ivy Pham, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2222146 | CVS Pharmacy, Inc | Certificate of waiver | Apr 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #07575 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090408000170 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092711895 | This NPI is an additional NPI on the enrollment |
| O20100930062213 | TX | DME Supplier - Pharmacy | 5092711895 | Practice locations: Fort Worth, TX |
National Provider Directory
- Tax ID family
- CVS Pharmacy Inc Agent for CVS RX Services Inc
Locations
5012 Trail Lake Dr
Fort Worth, TX 76133
Phone (817) 292-1700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | TX | ||
| Pharmacy | 333600000X | 24849 | TX | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
5012 Trail Lake Dr
Fort Worth, TX 76133-2028
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 210394701 | Other | TX | DME |
| 4586751 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 000463450 | Medicaid | TX |
Other names
- CVS PHARMACY #07575
Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.