NPIMap

Organization Active NPI

Mississippi CVS Pharmacy LLC

Doing business as CVS Pharmacy #00047

  • Pharmacy
  • D'Iberville, MS
National Provider Identifier
1942562533
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MISSISSIPPI CVS PHARMACY LLC
Doing business as
CVS Pharmacy #00047
Practice address
12024 Lamey Bridge Rd
Diberville, MS 39540-8906
Phone
(228) 396-2858
NPI assigned
Jun 11, 2012
Last updated
Apr 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

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 NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

12024 Lamey Bridge Rd
Diberville, MS 39540-8906

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
00323510MedicaidMS
04484010OtherMSMEDICAID DME
2588830OtherNCPDP

Other names 1

  • CVS Pharmacy #00047 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101230001038 MS Part B Supplier - Mass Immunization (Roster Biller Only) 9335344456 This NPI is an additional NPI on the enrollment
Practice locations: Picayune, MS; Pascagoula, MS; Oxford, MS; Olive Branch, MS; Ocean Springs, MS; Natchez, MS; Laurel, MS; Meridian, MS…
O20121023000161 MS DME Supplier - Pharmacy 9335344456 Practice locations: Diberville, MS

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
CVS Pharmacy #0004712024 Lamey Bridge Rd, Diberville, MS 39540-8906(228) 396-2858 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 assignmentParticipating since Jan 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Mississippi CVS Pharmacy LLC48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1942562533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "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": "12024 LAMEY BRIDGE RD",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395408906",
            "telephone_number": "228-396-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2013-04-17",
        "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": "NU",
            "license": null,
            "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": "00323510",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "04484010",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2588830",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #00047",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in D'Iberville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.

Verify at the official NPI Registry.