MISSISSIPPI CVS PHARMACY LLC (NPI# 1730311689) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730311689 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CVS PHARMACY LLC |
| Other Organization Name | CVS PHARMACY #17532 |
| Practice Address |
3867 Promenade Pkwy Diberville MS 39540-5372 |
| Mailing Address |
1 Cvs Dr Box 1075 Woonsocket RI 02895-6146 |
| Practice Telephone | 2282333302 |
| Practice Fax Number | 2282333312 |
| Mailing Telephone | 4017651500 |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2016-11-04 |
| 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 |
08227/1.2 | MS | Suppliers |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2121409 | 01 |
| Other Name | Type Code |
|---|---|
| CVS Pharmacy #17532 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740682210 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1435 N. Frontage Rd, Vicksburg, MS 39180-5170 | 2014-09-16 |
| 1710314463 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 365 Cole Rd, Hattiesburg, MS 39402 | 2013-09-26 |
| 1770826158 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 801 Highway 80 E, Clinton, MS 39056-5252 | 2013-04-03 |
| 1942562533 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 12024 Lamey Bridge Rd, Diberville, MS 39540-8906 | 2012-06-11 |
| 1922366756 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1912 Jackson Ave W, Oxford, MS 38655-4454 | 2012-04-30 |
| 1356618979 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 800 E Fifteenth St, Yazoo City, MS 39194-7625 | 2011-11-28 |
| 1366735185 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2507 Hardy St, Hattiesburg, MS 39401-5914 | 2011-05-26 |
| 1598054082 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 750 City Ave S, Ripley, MS 38663-2520 | 2011-04-05 |
| 1528229614 | Mississippi Cvs Pharmacy LLC | Pharmacy | 5150 Goodman Rd, Olive Branch, MS 38654-7903 | 2008-06-20 |
| 1174798417 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 6040 Goodman Rd, Walls, MS 38680 | 2008-04-28 |
| Street Address |
3867 PROMENADE PKWY |
| City | DIBERVILLE |
| State | MS |
| Zip Code | 39540-5372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689163024 | Trung Nguyen | Pharmacist | 3867 Promenade Pkwy, Diberville, MS 39540-5372 | 2018-05-01 |
| 1346535564 | Chasty Patrice Grady | Pharmacist | 3867 Promenade Pkwy, Diberville, MS 39540-5372 | 2011-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528347531 | Lindsey Rachelle Cuevas | Pharmacist | 10551 D'iberville Blvd, D'iberville, MS 39540 | 2011-08-08 |
| 1750438255 | Andrea L Davis | Dentist | 11505 Cinema Drive, Suite 6, D'iberville, MS 39540 | 2007-01-05 |
| 1750308250 | South Mississippi Urgent Care | Clinic/Center | 3661 Sangani Blvd, Suite E, Dlberville, MS 39540 | 2006-07-17 |
| 1568948016 | Courtney Leigh Ponder | Nurse Practitioner | 11516 Lamey Bridge Rd Ste I, Diberville, MS 39540 | 2018-07-18 |
| 1134635360 | Southern Regional Chiropractic and Rehabilitation Center | Nurse Practitioner | 11505 Cinema Dr Ste 7, Diberville, MS 39540 | 2017-12-26 |
| 1487177481 | Walgreen Co | Pharmacy | 4031 Popps Ferry Rd Ste A, Diberville, MS 39540 | 2017-07-21 |
| 1891151817 | Total Renal Care Inc | Clinic/Center | 3200 Mallett Rd, Ste F, Diberville, MS 39540 | 2016-01-06 |
| 1679944763 | Katelyn Elizabeth Martin | Behavioral Analyst | 4061 Suzanne Dr, Diberville, MS 39540 | 2015-10-14 |
| 1467880922 | Carla Diane Diffenderfer | Nurse Practitioner | 11516 Lamey Bridge Rd Ste I, Diberville, MS 39540 | 2013-10-21 |
| 1982618369 | Becky F Hollibaugh | Family Medicine | 3920 Promenade Pkwy, Biloxi, MS 39540 | 2006-07-28 |
| Find all providers in zip 39540 | ||||
| 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 |
|---|---|---|---|---|
| 1891712212 | Wal-mart Stores East Lp | Pharmacy | 3615 Sangani Blvd, Diberville, MS 39540-8770 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457973067 | Thomas Street Compounding Pharmacy | Pharmacy | 115 N Thomas St Ste G, Tupelo, MS 38801-3082 | 2020-05-18 |
| 1013558824 | Downhome Pharmacy, Inc. | Pharmacy | 606 W. Broad St, Monticello, MS 39654 | 2019-10-02 |
| 1356997985 | Sonshine Pharmacy, LLC | Pharmacy | 2745 Highway 371 N, Mantachie, MS 38855 | 2019-08-09 |
| 1699331868 | Fulton Specialty Pharmacy, LLC | Pharmacy | 1509 S Adams St Ste D, Fulton, MS 38843-6621 | 2019-05-14 |
| 1063971539 | National Pharmacy of Mississippi, LLC | Pharmacy | 371b Highland Colony Pkwy, Ridgeland, MS 39157-6035 | 2019-03-14 |
| 1811468952 | Davidson Pharmacy, LLC | Pharmacy | 203a N 2nd St, Booneville, MS 38829-2701 | 2018-12-16 |
| 1346710720 | Tupelo Specialty Pharmacy, LLC | Pharmacy | 1056 Cliff Gookin Blvd Ste C, Tupelo, MS 38801-6458 | 2018-11-28 |
| 1205302254 | A & A Infusion & Specialty, LLC | Pharmacy | 423 Mcallister St, Greenville, MS 38701-4704 | 2018-10-17 |
| 1306325402 | Family Drug Mart of Poplarville,llc | Pharmacy | 100 Highway 11 N, Poplarville, MS 39470-2217 | 2018-08-09 |
| 1851883789 | Amory Discount Pharmacy, LLC | Pharmacy | 60379 Cotton Gin Port Rd Ste B, Amory, MS 38821-7204 | 2018-06-06 |
| Find all providers with the same taxonomy | ||||
| City | DIBERVILLE |
| Zip Code | 39540 |
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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.