MAIN STREET PHARMACY, LLC (NPI# 1588845754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588845754 |
| Entity Type | Organization |
| Organization Name | MAIN STREET PHARMACY, LLC |
| Other Organization Name | CVS PHARMACY #48353 |
| Practice Address |
14703 Eagle Vista Dr Houston TX 77077-5275 |
| Mailing Address |
1 Cvs Dr Box 1075 Woonsocket RI 02895-6146 |
| Practice Telephone | 2812497290 |
| Mailing Telephone | 4017651500 |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2016-08-01 |
| Authorized Official Name | SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS) |
| Authorized Official Telephone | 4017702751 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
26012 | TX | Suppliers |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 146568 | 05 | |
| NCPDP | 4546327 | 01 |
| Other Name | Type Code |
|---|---|
| CVS Pharmacy #48353 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295158582 | Main Street Pharmacy, LLC | Pharmacy | 3100 Shore Dr, Virginia Beach, VA 23451-1199 | 2014-01-23 |
| 1649539420 | Main Street Pharmacy, LLC | Pharmacy | 1600 Westbrook Ave, Richmond, VA 23227-3337 | 2012-05-14 |
| 1942407671 | Main Street Pharmacy, LLC | Pharmacy | 203 Linden Ponds Way, Hingham, MA 02043 | 2007-06-27 |
| 1710054051 | Main Street Pharmacy, LLC | Pharmacy | 100 Maris Grove Way, Glen Mills, PA 19342 | 2006-11-30 |
| 1326115106 | Main Street Pharmacy, LLC | Pharmacy | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2006-11-29 |
| 1457448672 | Main Street Pharmacy, LLC | Pharmacy | 10000 Shannondell Dr, Audubon, PA 19403-5615 | 2006-10-09 |
| 1710087085 | Main Street Pharmacy, LLC | Pharmacy | 7440 Spring Village Dr, Springfield, VA 22150-4446 | 2006-09-25 |
| 1225138514 | Main Street Pharmacy, LLC | Pharmacy | 3110 Gracefield Rd, Silver Spring, MD 20904-1820 | 2006-09-25 |
| 1942300223 | Main Street Pharmacy, LLC | Pharmacy | 4800 Fillmore Ave, Alexandria, VA 22311-5070 | 2006-09-25 |
| 1427158724 | Main Street Pharmacy, LLC | Pharmacy | 3000 Essex Rd, Tinton Falls, NJ 07753-2631 | 2006-09-25 |
| Street Address |
14703 EAGLE VISTA DR |
| City | HOUSTON |
| State | TX |
| Zip Code | 77077-5275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144224544 | Raina Patel | Internal Medicine | 14703 Eagle Vista Dr, Houston, TX 77077-5275 | 2005-06-13 |
| 1922537034 | Sidratu Rugie Issa | Nurse's Aide | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2017-06-12 |
| 1013312792 | Crystal Taylor | Physical Therapy Assistant | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2014-10-24 |
| 1841695657 | Rushina Desai | Physical Therapy Assistant | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2014-10-23 |
| 1992109854 | Barbara Craver | Occupational Therapist | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2014-10-21 |
| 1386984912 | Jennifer Blan | Speech-Language Pathologist | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2013-02-19 |
| 1144580192 | Eagle's Trace Inc | Skilled Nursing Facility | 14703 Eagle Vista Dr, Attn: Extended Care Administrator, Houston, TX 77077-5394 | 2012-05-24 |
| 1568741536 | Chisaokwu Abdullah | Speech-Language Pathologist | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2011-08-09 |
| 1972805117 | Cynthia Marie Dupont | Physical Therapist | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2010-11-20 |
| 1861706558 | Erickson Health Medical Group of Texas, Pa | Durable Medical Equipment & Medical Supplies | 14703 Eagle Vista Dr, Houston, TX 77077-5394 | 2010-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407457922 | Tam Minh Ha | Pharmacist | 2700 S Kirkwood, Houston, TX 77077 | 2020-11-02 |
| 1497396881 | Laboratory Concepts | Technician, Pathology | 2025 Gentryside Dr, Houston, TX 77077 | 2019-10-07 |
| 1447730940 | Olufunke O'banion | Registered Nurse | 1011 South Texas 6, Suite 311, Houston, TX 77077 | 2018-08-15 |
| 1548753536 | Jasmine M Mckenzie | Specialist | 12350 Westhemier Rd, Suite 128, Houston, TX 77077 | 2018-06-13 |
| 1396233698 | Waabeke Charlotte Nwikpo | Counselor | 1919 S Kirkwood Rd Apt 144, Houston, TX 77077 | 2018-04-23 |
| 1447747894 | Westside Medical Centers of Texas Pllc | Chiropractor | 1137 Highway 6 South, Houston, TX 77077 | 2018-04-20 |
| 1649786427 | Medical Care Innovation, P.C. | Clinic/Center | 1254 Enclave Parkway, Houston, TX 77077 | 2017-12-16 |
| 1194242545 | Lydia Danielle Breedlove | Specialist/Technologist | 12310 Rincon Drive, Houston, TX 77077 | 2017-08-26 |
| 1649602962 | Bereket Haileab Tsegai | Optometrist | 11660 Westheimer Rd Ste 125, Houston, TX 77077 | 2013-08-09 |
| 1851733273 | Tomekia Alvarez | Occupational Therapy Assistant | 1815 Enclave Parkway, Apt 6307, Houston, TX 77077 | 2013-07-26 |
| Find all providers in zip 77077 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174120562 | Medela Pharmacy Inc | Pharmacy | 6550 Mapleridge St Ste 200, Houston, TX 77081-4647 | 2020-10-08 |
| 1164037594 | Nanes Pharmacy LLC | Pharmacy | 17030 Nanes Dr Ste 105a, Houston, TX 77090-2503 | 2020-09-11 |
| 1265045751 | Homecare Pharmacy LLC | Pharmacy | 8700 S Braeswood Blvd Ste B2, Houston, TX 77031-1338 | 2020-08-25 |
| 1245857051 | Blue City LLC | Pharmacy | 2646 S Loop W Ste 180a, Houston, TX 77054-5616 | 2020-06-26 |
| 1891315412 | Cvs Pharmacy Inc | Pharmacy | 17977 Fm 529 Rd, Houston, TX 77095-1005 | 2020-04-23 |
| 1154951390 | Medrx Specialty Pharmacy, LLC | Pharmacy | 19255 Park Row Ste 103, Houston, TX 77084-7310 | 2020-01-15 |
| 1215582184 | Sky Rx LLC | Pharmacy | 9073 S Dairy Ashford Rd, Houston, TX 77099-1215 | 2019-08-07 |
| 1467006924 | Sphinx Pharmacy Group Webster Inc | Pharmacy | 2656 S Loop W Suite 275, Houston, TX 77054 | 2019-08-01 |
| 1861960858 | Delcey Pharmacy LLC | Pharmacy | 8700 Commerce Park Dr Ste 121, Houston, TX 77036-7423 | 2018-11-07 |
| 1932691847 | Amerrx Pharmaceuticals Incorporated | Pharmacy | 5003 Antoine Dr Ste A, Houston, TX 77092-3348 | 2018-06-06 |
| Find all providers in HOUSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.