Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy 07883
- Pharmacy
- Vero Beach, FL
National Provider Identifier
1902900988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 20231
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy 07883
- Practice address
- 4215 9TH St SW
Vero Beach, FL 32968-4806 - Phone
- (772) 564-8235
- Fax
- (772) 564-8698
- NPI assigned
- Sep 12, 2006
- Last updated
- Dec 4, 2012
- 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
- Cristiana Mauricio
- Title
- MGR Phcy Enrollments
- Phone
- (401) 770-2937
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 20231 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4215 9TH St SW
Vero Beach, FL 32968-4806
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 026729500 | Medicaid | FL | |
| 1002954 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY 07883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081223000620 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668534702 | This NPI is an additional NPI on the enrollment |
| O20100930060145 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Vero Beach, FL |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2224059 | Holiday CVS, LLC Dba CVS/Pharmacy #7883 | Certificate of waiver | May 10, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Holiday CVS LLC | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- CVS
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
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": "1354579200000",
"number": "1902900988",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4215 9TH ST SW",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329684806",
"telephone_number": "772-564-8235",
"fax_number": "772-564-8698"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2012-12-04",
"status": "A",
"authorized_official_last_name": "MAURICIO",
"authorized_official_first_name": "CRISTIANA",
"authorized_official_title_or_position": "MGR PHCY ENROLLMENTS",
"authorized_official_telephone_number": "401-770-2937"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "20231",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026729500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1002954",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 07883",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vero Beach, FL
- Holiday CVS LLC (CVS Pharmacy 07894)
- Holiday CVS LLC (CVS Pharmacy #05522)
- Holiday CVS LLC (CVS Pharmacy #03429)
- Holiday CVS LLC (CVS Pharmacy #03216)
- Holiday CVS LLC (CVS Pharmacy #00584)
- Holladay Consulting, LLC
- Brent Holladay, M.A.
- David Sjur Holland, PSY.D.
- Sean Lee Holland, LMT
- Hollinger MD PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.