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Export Provider Record NPI 1053415802
Pennsylvania Cvs Pharmacy, L.l.c.
Organization Subpart: NO
Active
NPI Number1053415802
NPI TypeNPI-2 Organization
SpecialtyPharmacy
Provider Details
NPI1053415802
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2006-09-12
Last Updated2015-02-23
Authorized OfficialSusan Colbert
Director, Payer Relations
Phone: 4017702751
Mailing Address1 Cvs Dr, Po Box 1075
Woonsocket, RI 02895-6146
United States
Phone: (401) 765-1500
📍 View Map
Primary Practice Address239 Fox Run Lane
E Stroudsburg, PA 18302-9120
United States
Phone: (570) 223-6893
📍 View Map
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)3970123Other ID Number-Commercial Number
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
No332B00000X – Durable Medical Equipment & Medical Supplies
No3336C0003X – Pharmacy, Community/Retail Pharmacy
Yes333600000X – PharmacyPAPP415044L
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About NPI 1053415802

Pennsylvania Cvs Pharmacy, L.l.c. is an organization registered in the CMS NPPES NPI Registry with NPI number 1053415802. The primary specialty listed is Pharmacy. The organization is located in E Stroudsburg, PA. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-09-12. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1053415802?

NPI 1053415802 belongs to Pennsylvania Cvs Pharmacy, L.l.c., a Pharmacy in E Stroudsburg, PA. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1053415802 active?

The current status of NPI 1053415802 in the NPPES registry is Active. The record was last updated on 2015-02-23.

What specialty is NPI 1053415802?

NPI 1053415802 is classified under the taxonomy Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1053415802?

You can verify NPI 1053415802 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1053415802?

The primary practice address on file for NPI 1053415802 is 239 Fox Run Lane, E Stroudsburg, PA 18302-9120. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1053415802 issued?

NPI 1053415802 was first issued (enumerated) on 2006-09-12. The NPPES record was last updated on 2015-02-23.

Practice Location Map

Pennsylvania Cvs Pharmacy, L.l.c. is located at 239 Fox Run Lane, E Stroudsburg, PA. Use the map below to find directions or verify the practice location.

📍 239 Fox Run Lane, E Stroudsburg, PA 18302-9120  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Pennsylvania Cvs Pharmacy, L.l.c.. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1053415802. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
PharmacyPP415044LPA
Data Verified from CMS NPPES Last synced: 2026-06-15 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162