South Carolina CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Columbia, SC
NPI 1992965263 · NPPES record last updated Nov 19, 2010
Key facts
- NPI
- 1992965263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- SOUTH CAROLINA CVS PHARMACY, L.L.C.
- Practice address
- 1002 Sams Crossing Road
Columbia, SC 29229 - Phone
- (803) 788-0535
- NPI assigned
- Jun 11, 2008
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 12
Member of 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930100456 | SC | DME Supplier - Pharmacy | 7214130400 | Practice locations: Columbia, SC |
| O20101021000051 | SC | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214130400 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- South Carolina CVS Pharmacy LLC
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
1002 Sams Crossing Road
Columbia, SC 29229
Mailing address
1 CVS Dr
Box 1075- Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4227775 | Other | NCPDP # | |
| 710053 | Other | SC MED RX LEGACY # | |
| DE3143 | Other | SC | SC MEDICAID DME LEGACY # |
| 1992965263 | Medicaid | SC |
Other names
- CVS Pharmacy #01200
Other providers in Columbia, SC
- South Carolina CVS Pharmacy LLC
- South Carolina CVS Pharmacy LLC
- South Carolina CVS Pharmacy, L.L.C.
- South Carolina CVS Pharmacy, L.L.C.
- South Carolina CVS Pharmacy, L.L.C.
- South Carolina Department of Corrections
- South Carolina Department of Education
- South Carolina Department of Juvenile Justice
- South Carolina Department of Juvenile Justice
- South Carolina Department of Juvenile Justice
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2010. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.