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Ohio CVS Stores LLC

Organization Active NPI Pharmacy · Cheviot, OH

NPI 1992808653 · NPPES record last updated Jan 17, 2023

Key facts

NPI
1992808653
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
02-0485700 (OH)
Legal business name
OHIO CVS STORES LLC
Practice address
4110 Harrison Ave
Cheviot, OH 45211-4556
Phone
(513) 574-1770
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Dir., Managed Care Administration
Phone
(401) 770-2751

Corporate family (same tax ID) 14

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

Member of 1

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

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2255672Ohio CVS Stores, LLC Dba
4110 Harrison Ave, Cheviot, OH 45211		Certificate of waiverMar 15, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #06129
4110 Harrison Ave, Cheviot, OH 45211-4556 · (513) 574-1770		 Immunosuppressive Drugs|Infusion 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|Urologic… Does not accept assignment
Participating since Jan 1, 2019

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OH

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930036419 OH DME Supplier - Pharmacy 4981806023 Practice locations: Cheviot, OH
O20101111000369 OH Part B Supplier - Mass Immunization (Roster Biller Only) 4981806023 This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
CVS Pharmacy 05364 (311 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 02-0485700 OH Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4110 Harrison Ave
Cheviot, OH 45211-4556

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146

Other identifiers

IdentifierTypeStateIssuer
3644413OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY #06129 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Cheviot, OH

All providers in Cheviot, OH · Pharmacy in Ohio

Sources for this page

Verify at the official NPI Registry.