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HOLIDAY CVS LLC NPI 1114021078


NPI Information

NPI: 1114021078
Provider Name: HOLIDAY CVS LLC

Doing Business As: CVS PHARMACY 05169

Classification: Pharmacy - 333600000X
Entity Type: Organization

CLIA Number: 10D2224569

Address:
100 2ND AVE SE
JASPER, FL
ZIP 32052
Phone: (386) 792-2551
Get Directions

HOLIDAY CVS LLC is a pharmacy in Jasper, FL. 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. HOLIDAY CVS LLC NPI is 1114021078. The provider is registered as an organization entity type.
The provider Is Doing Business As Cvs Pharmacy 05169.

The provider's business location address is:

100 2ND AVE SE
JASPER, FL
ZIP 32052-114
Phone: (386) 792-2551
Fax: (386) 792-3577

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

The CLIA number assigned to this NPI record is 10D2224569 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/12/2006 and was last updated on 11/21/2012.


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
13336C0003XPharmacyCommunity/Retail PharmacyNo
2333600000XPharmacy20642FLORIDAYes

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
15140820478MEDICARE NSC
21079171OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3BC034CMEDICARE PINFLORIDA
4105940800MEDICAIDFLORIDA

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: 5/5/2024

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