Active NPI
Washington CVS Pharmacy LLC
Doing business as CVS Pharmacy #11663
- Pharmacy
- Mountlake Terrace, WA
National Provider Identifier
1982714663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- WASHINGTON CVS PHARMACY LLC
- Doing business as
- CVS Pharmacy #11663
- Practice address
- 22803 44TH Ave W
Mountlake Terrace, WA 98043-5032 - Phone
- (425) 771-3738
- Fax
- (425) 776-1190
- NPI assigned
- Aug 30, 2006
- 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
- Sr. Director, Payer Relations
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X | CF00002429 | WA |
Addresses
Primary practice location
22803 44TH Ave W
Mountlake Terrace, WA 98043-5032
Mailing address
1 CVS Dr
Woonsocket, RI 02895-6146
Other names 1
- CVS Pharmacy #11663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040226000423 | WA | Part B Supplier - Pharmacy | 2062305501 | This NPI is an additional NPI on the enrollment |
| O20150505002664 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224259734 |
This NPI is an additional NPI on the enrollment Practice locations: Puyallup, WA; Redmond, WA; Renton, WA; Richland, WA; Seattle, WA; Silverdale, WA; Spokane, WA; Tacoma, WA… |
| O20250912000581 | WA | DME Supplier - Pharmacy | 8224259734 | Practice locations: Mountlake Terrace, WA |
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 |
|---|---|---|---|
| 50D2328217 | CVS Pharmacy #11663 | Certificate of waiver | Apr 4, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #11663 | 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
- Washinton CVS Pharmacy LLC
Organizations with this tax ID in the same state 13
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": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1753142400000",
"number": "1982714663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22803 44TH AVE W",
"city": "MOUNTLAKE TERRACE",
"state": "WA",
"postal_code": "980435032",
"telephone_number": "425-771-3738",
"fax_number": "425-776-1190"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WASHINGTON CVS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-30",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "SR. DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "WA",
"license": "CF00002429",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #11663",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mountlake Terrace, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.