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CVS PHARMACY #04668
NPI 1053414888
Pharmacy in Powder Springs, GA

Active since September 07, 2006CLIA 11D2282790 · Waiver
2091 LOST MOUNTAIN RD, POWDER SPRINGS, GA 30127(770) 943-4137 Get Directions Write a Review

NPPES record last updated: February 2, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Cvs Pharmacy #04668 NPPES

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

CVS PHARMACY #04668 (NPI 1053414888) is a healthcare organization registered as a pharmacy in Powder Springs, Georgia and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through May 24, 2027 and lists Susan F Colbert, Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1053414888
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameGEORGIA CVS PHARMACY, L.L.C.
Location Address2091 LOST MOUNTAIN RDPowder Springs, GA 30127-1122
Mailing Address1 Cvs Dr, Po Box 1075Woonsocket, RI 02895-6146 · (401) 765-1500
Phone(770) 943-4137
Organization SubpartNo
Authorized OfficialSusan F ColbertDirector, Payer Relations · (401) 770-2751
Enumeration DateSeptember 7, 2006
Last NPPES UpdateFebruary 2, 2017
✔ NPI 1053414888 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in GA · 005611
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
2091 LOST MOUNTAIN RD, Powder Springs, GA 30127
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Other Names 1

Doing Business AsCvs Pharmacy #04668

Other Identifiers 5

Medicare PIN202G738984
Medicare NSC5754010135
Medicare PINP00962782GA
Other1133797Other Id Number-commercial Number
Medicaid000388418AGA

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 Arizona Complete Health and more.Insurance ›

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 11D2282790

Georgia CVS Pharmacy, LLC Dba Cvs/Pharmacy #04668 · Powder Springs, GA
Active · expires May 24, 2027
CLIA Number11D2282790
Laboratory TypePharmacy
Certificate Effective DateMay 25, 2025
Certificate Expiration DateMay 24, 2027
Laboratory DirectorJuliet Moghalu
Laboratory Phone(770) 943-4136
Laboratory LocationGeorgia CVS Pharmacy, LLC Dba Cvs/Pharmacy #046682091 Lost Mountain Rd, Powder Springs, GA 30127
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 5

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.
147 services146 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.
102 services102 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.
39 services39 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
14 services14 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
14 services14 patients

Medical Equipment Supplier Medicare DMEPOS 18

Medicare supplier enrollment and the product categories CVS Pharmacy # 04668 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy # 04668

DMEPOS supplier · Powder Springs, GAOperated by Georgia CVS Pharmacy, L.L.C.
✔

Accepts Medicare assignment

CVS Pharmacy # 04668 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)20326439
Medicare Participant SinceJanuary 1, 2023
Supplier Location2091 Lost Mountain Rd SWPowder Springs, GA 30127
Phone(770) 943-4136
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
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
Blood Glucose Monitors/Supplies (Non-Mail Order)
Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
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

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

DR. VINCENT JAMAR WILCOX PHARMD
Pharmacist
2091 LOST MOUNTAIN RD
POWDER SPRINGS, GA 30127
Cobb County (770) 943-4136

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 Georgia CVS Pharmacy, L.L.C.'s NPI number?

The NPI number for Georgia CVS Pharmacy, L.L.C. is 1053414888. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as CVS Pharmacy #04668.

Where is Georgia CVS Pharmacy, L.L.C. located?

Georgia CVS Pharmacy, L.L.C. is located at 2091 Lost Mountain Rd, Powder Springs, GA 30127. The listed phone number is (770) 943-4137.

What is Georgia CVS Pharmacy, L.L.C.'s specialty?

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

Does Georgia CVS Pharmacy, L.L.C. accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, CVS Pharmacy # 04668 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Georgia CVS Pharmacy, L.L.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2282790) is associated with this NPI, valid through May 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Georgia CVS Pharmacy, L.L.C. accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 33 other insurers list Georgia CVS Pharmacy, L.L.C. 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 Georgia CVS Pharmacy, L.L.C. was last updated on February 2, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.