GEORGIA CVS PHARMACY LLC NPI 1710080551

NPI Information

NPI: 1710080551
Provider Name: GEORGIA CVS PHARMACY LLC

Doing Business As: CVS PHARMACY # 05618

Classification: Pharmacy - 333600000X
Entity Type: Organization

Address:
11685 COLUMBIA ST
BLAKELY, GA
ZIP 39823
Phone: (912) 723-4271
Get Directions

GEORGIA CVS PHARMACY LLC is a pharmacy in Blakely, GA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. GEORGIA CVS PHARMACY LLC NPI is 1710080551. The provider is registered as an organization entity type.
The provider Is Doing Business As Cvs Pharmacy # 05618.

The provider's business location address is:

11685 COLUMBIA ST
BLAKELY, GA
ZIP 39823-573
Phone: (912) 723-4271

The provider's authorized official is Susan Colbert .
The authorized official title is Director, Payer Relations and has the following contact phone number (401) 770-2751.

The CLIA number assigned to this NPI record is 11D2282589 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/7/2006 and was last updated on 4/14/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3336C0003X	Pharmacy	Community/Retail Pharmacy			No
2	332B00000X	Durable Medical Equipment & Medical Supplies			GEORGIA	No
3	333600000X	Pharmacy		005504	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000186711A	MEDICAID	GEORGIA
2	202G738984	MEDICARE PIN
3	P00962782	MEDICARE PIN	GEORGIA
4	1124623	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
5	5754010234	MEDICARE NSC	GEORGIA
6	1710080551	MEDICAID	ALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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