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CVS PHARMACY #17612
NPI 1023452851
Pharmacy in Lawton, OK

Active since April 23, 2013CLIA 37D2282421 · Waiver
2030 NW 82ND ST, LAWTON, OK 73505(580) 354-7275(580) 354-7285 Get Directions Write a Review

NPPES record last updated: January 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 13, 2023, Oct 25, 2016, Aug 25, 2016 and 1 more (4 updates tracked since 2016).

About Cvs Pharmacy #17612 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CVS PHARMACY #17612 (NPI 1023452851) is a healthcare organization registered as a pharmacy in Lawton, Oklahoma and active in the NPI registry since April 2013. The organization holds a CLIA Waiver certificate valid through May 21, 2027 and lists Susan Colbert, Sr. Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1023452851
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameOKLAHOMA CVS PHARMACY LLC
Location Address2030 NW 82ND STLawton, OK 73505-2355
Mailing Address1 Cvs Dr, Box 1075Woonsocket, RI 02895-6146 · (401) 765-1500
Phone(580) 354-7275
Fax(580) 354-7285
Organization SubpartNo
Authorized OfficialSusan ColbertSr. Director, Payer Relations · (401) 770-2751
Enumeration DateApril 23, 2013
Last NPPES UpdateJanuary 13, 20234 updates tracked since enumeration
NPPES CertifiedJanuary 13, 2023
✔ NPI 1023452851 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
Definition
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.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X · License 3-7628 (OK)
2030 NW 82ND ST, Lawton, OK 73505
Open in Google Maps ↗

Other Names 1

Doing Business AsCvs Pharmacy #17612

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cvs Pharmacy #17612 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateOklahomaEnrollment IDO20100903000320Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D2282421

Cvs/Pharmacy #10520 Oklahoma CVS Pharmacy, LLC · Lawton, OK
Active · expires May 21, 2027
CLIA Number37D2282421
Laboratory TypePharmacy
Certificate Effective DateMay 22, 2025
Certificate Expiration DateMay 21, 2027
Laboratory DirectorCourtney Hicks
Laboratory Phone(866) 389-2727
Laboratory LocationCvs/Pharmacy #10520 Oklahoma CVS Pharmacy, LLC2107 NW Cache Road, Lawton, OK 73505
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
128 services126 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
97 services97 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
26 services26 patients

Medical Equipment Supplier Medicare DMEPOS 19

Medicare supplier enrollment and the product categories CVS Pharmacy #17612 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #17612

DMEPOS supplier · Lawton, OKOperated by Oklahoma CVS Pharmacy LLC
✔

Accepts Medicare assignment

CVS Pharmacy #17612 agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20308967
Medicare Participant SinceJanuary 1, 2023
Supplier Location2030 NW 82nd StLawton, OK 73505
Phone(580) 354-7275
Supplier Specialties
Pharmacy

Medicare Product Categories

Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Commodes, Urinals, Bedpans
Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK RAYMOND GUINUP JR. PHARMD
Pharmacist
2030 NW 82ND ST, T-2739
LAWTON, OK 73505
Comanche County (580) 354-7275
MARK DODSON
Pharmacist
2030 NW 82ND ST
LAWTON, OK 73505
Comanche County (580) 354-7275
MRS. AMANDA L EARY PHARM.D
Pharmacist
2030 NW 82ND ST
LAWTON, OK 73505
Comanche County (580) 354-7275
EUGENE JANZ D PH
Pharmacist
2030 NW 82ND ST
LAWTON, OK 73505
Comanche County (580) 354-7275

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Oklahoma CVS Pharmacy LLC's NPI number?

The NPI number for Oklahoma CVS Pharmacy LLC is 1023452851. It was assigned to this organization in the NPPES registry on April 23, 2013. The provider is doing business as CVS Pharmacy #17612.

Where is Oklahoma CVS Pharmacy LLC located?

Oklahoma CVS Pharmacy LLC is located at 2030 NW 82nd St, Lawton, OK 73505. The listed phone number is (580) 354-7275.

What is Oklahoma CVS Pharmacy LLC's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Is Oklahoma CVS Pharmacy LLC enrolled in Medicare?

Yes. Oklahoma CVS Pharmacy LLC is registered in the Medicare PECOS enrollment system.

When is Oklahoma CVS Pharmacy LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Oklahoma, Mass Immunization (Roster Biller Only)) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Oklahoma CVS Pharmacy LLC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, CVS Pharmacy #17612 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Oklahoma CVS Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2282421) is associated with this NPI, valid through May 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Oklahoma CVS Pharmacy LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 34 other insurers list Oklahoma CVS Pharmacy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Oklahoma CVS Pharmacy LLC was last updated on January 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.