North Carolina CVS Pharmacy LLC
Organization Active NPI Pharmacy · Raleigh, NC
NPI 1982911616 · NPPES record last updated Jan 18, 2023
Key facts
- NPI
- 1982911616
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- NORTH CAROLINA CVS PHARMACY LLC
- Practice address
- 4309 New Bern Ave
Raleigh, NC 27610-1445 - Phone
- (919) 231-2858
- NPI assigned
- Sep 1, 2010
- Organization subpart
- No
Authorized official
- Name
- Susan F Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 14
Member of 1
Practitioners 7
-
Obinna J Achumba, PHARMD
-
Brian Anthony Bach, RPH
-
Kristopher Dean McLamb, PHARMD
-
Mustafa Oudeh, PHARMD
-
Erin Tenney, PHARMD, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2284132 | North Carolina CVS Pharmacy, LLC Dba | Certificate of waiver | Jun 18, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #07513 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080116000795 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 9133200017 | This NPI is an additional NPI on the enrollment |
| O20101120000196 | NC | DME Supplier - Pharmacy | 9133200017 | Practice locations: Raleigh, NC |
National Provider Directory
- Tax ID family
- North Carolina CVS Pharmacy
Locations
4309 New Bern Ave
Raleigh, NC 27610
Phone (919) 231-2858
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4309 New Bern Ave
Raleigh, NC 27610-1445
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0920532 | Medicaid | NC | |
| 3421435 | Other | NC | NCPDP |
Other names
- CVS PHARMACY #07513
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
Other providers in Raleigh, NC
- North Carolina CVS Pharmacy LLC
- North Carolina CVS Pharmacy LLC
- North Carolina CVS Pharmacy LLC
- North Carolina CVS Pharmacy LLC
- North Carolina CVS Pharmacy LLC
- North Carolina CVS Pharmacy, L.L.C.
- North Carolina CVS Pharmacy, LLC
- North Carolina Dermatology Associates, PLLC
- North Carolina Elderly Psychiatric
- North Carolina Endodontics
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.