Active NPI
Holiday CVS LLC
Doing business as CVS Pharmacy 05176
- Pharmacy
- Gulf Breeze, FL
National Provider Identifier
1912001884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 20475
- Legal business name
- HOLIDAY CVS LLC
- Doing business as
- CVS Pharmacy 05176
- Practice address
- 225 Gulf Breeze Pkwy
Gulf Breeze, FL 32561-4465 - Phone
- (850) 934-0030
- Fax
- (850) 634-6190
- NPI assigned
- Sep 12, 2006
- Last updated
- Oct 24, 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
- Susan F Colbert
- Title
- Director Phcy Enrollments
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | 20475 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
225 Gulf Breeze Pkwy
Gulf Breeze, FL 32561-4465
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106357000 | Medicaid | FL | |
| 1082724 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY 05176
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 |
| O20100930079544 | FL | DME Supplier - Pharmacy | 2668534702 | Practice locations: Gulf Breeze, 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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #05176 | 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
- Holiday CVS 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.
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": "1351036800000",
"number": "1912001884",
"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": "225 GULF BREEZE PKWY",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614465",
"telephone_number": "850-934-0030",
"fax_number": "850-634-6190"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLIDAY CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-12",
"last_updated": "2012-10-24",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "DIRECTOR PHCY ENROLLMENTS",
"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": "FL",
"license": "20475",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106357000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1082724",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 05176",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gulf Breeze, FL
- Hinote Medical, LLC
- Erin Caroline Hinze, APRN
- Brittany Erland Hogan, NURSE PRACTITIONER
- Patrick Holcomb, PTA
- Holiday CVS LLC (CVS Pharmacy # 04155)
- Holiday Whisenant Counseling LLC (Holiday Whisenant Counseling)
- Home Medical Supply Solutions, Inc.
- Kerry Horvath, D.O.
- Jessica Mason Hosford, P.T.
- Marilyn K Howard, ARNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.