NPIMap

Organization Active NPI

Louisiana CVS Pharmacy, L.L.C.

Doing business as CVS Pharmacy #05396

  • Pharmacy
  • Bossier City, LA
National Provider Identifier
1891899738
Registry record updated Jul 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5963 Issued in LA
Legal business name
LOUISIANA CVS PHARMACY, L.L.C.
Doing business as
CVS Pharmacy #05396
Practice address
4890 Barksdale Blvd
Bossier City, LA 71112-4566
Phone
(318) 747-4330
Fax
(318) 746-2773
NPI assigned
Sep 12, 2006
Last updated
Jul 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2014

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X 5963 LA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

4890 Barksdale Blvd
Bossier City, LA 71112-4566

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1918690OtherOTHER ID NUMBER-COMMERCIAL NUMBER
001264971MedicaidLA

Other names 1

  • CVS PHARMACY #05396 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930079647 LA DME Supplier - Pharmacy 7113120312 Practice locations: Bossier City, LA
O20101011000003 LA Part B Supplier - Mass Immunization (Roster Biller Only) 7113120312 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Louisiana CVS Pharmacy120 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

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": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1891899738",
    "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": "4890 BARKSDALE BLVD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124566",
            "telephone_number": "318-747-4330",
            "fax_number": "318-746-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA CVS PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2014-07-10",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "5963",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1918690",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001264971",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #05396",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.