Active NPI
New Jersey CVS Pharmacy LLC
Doing business as CVS Pharmacy 00477
- Pharmacy
- Mount Ephraim, NJ
National Provider Identifier
1972687564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- RS03249
- Legal business name
- NEW JERSEY CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy 00477
- Practice address
- 7 South Black Horse Pike
Mount Ephraim, NJ 08059 - Phone
- (856) 931-6262
- NPI assigned
- Oct 24, 2006
- Last updated
- Dec 2, 2016
- 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 Colbert
- Title
- Director
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | RS03249 | NJ | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
7 South Black Horse Pike
Mount Ephraim, NJ 08059
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103222874001 | Medicaid | PA | |
| 3123899 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY 00477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100830000881 | NJ | Part B Supplier - Mass Immunization (Roster Biller Only) | 2365566288 | This NPI is an additional NPI on the enrollment |
| O20100930030635 | NJ | DME Supplier - Pharmacy | 3678777851 | Practice locations: Mount Ephraim, NJ |
National Provider Directory
National Provider Directory- Tax ID family
- New Jersey CVS Pharm LLC
Organizations with this tax ID in the same state 21
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": "1161648000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1480636800000",
"number": "1972687564",
"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": "7 SOUTH BLACK HORSE PIKE",
"city": "MOUNT EPHRAIM",
"state": "NJ",
"postal_code": "08059",
"telephone_number": "856-931-6262"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEW JERSEY CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-24",
"last_updated": "2016-12-02",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NJ",
"license": "RS03249",
"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": "103222874001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3123899",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 00477",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mount Ephraim, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.