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CVS PHARMACY #04896
NPI 1073817185
Pharmacy in Broken Arrow, OK

Active since January 04, 2011CLIA 37D2223941 · Waiver
1853 S ASPEN AVE, BROKEN ARROW, OK 74012(918) 251-9615 Get Directions Write a Review

NPPES record last updated: May 17, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Cvs Pharmacy #04896 NPPES

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

CVS PHARMACY #04896 (NPI 1073817185) is a healthcare organization registered as a pharmacy in Broken Arrow, Oklahoma and active in the NPI registry since January 2011. The organization holds a CLIA Waiver certificate valid through May 10, 2027 and lists Susan Colbert, Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1073817185
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameOKLAHOMA CVS PHARMACY LLC
Location Address1853 S ASPEN AVEBroken Arrow, OK 74012-5104
Mailing Address1 Cvs Dr, Box 1075-pharmacy EnrollmentsWoonsocket, RI 02895-6146 · (401) 765-1500
Phone(918) 251-9615
Organization SubpartNo
Authorized OfficialSusan ColbertDirector, Payer Relations · (401) 770-2751
Enumeration DateJanuary 4, 2011
Last NPPES UpdateMay 17, 2011
✔ NPI 1073817185 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
1853 S ASPEN AVE, Broken Arrow, OK 74012
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Other Names 1

Doing Business AsCvs Pharmacy #04896

Other Identifiers 5

Other3726467Ncpdp
Other100233690EOK · Medicaid Dme
Medicare PINOKB5986
Medicaid100233690FOK
Medicare NSC5887790044

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 37D2223941

Cvs/Pharmacy #04896 Oklahoma CVS Pharmacy, LLC · Broken Arrow, OK
Active · expires May 10, 2027
CLIA Number37D2223941
Laboratory TypePharmacy
Certificate Effective DateMay 11, 2025
Certificate Expiration DateMay 10, 2027
Laboratory DirectorSajidah Swar
Laboratory Phone(866) 389-2727
Laboratory LocationCvs/Pharmacy #04896 Oklahoma CVS Pharmacy, LLC1853 S Aspen Ave, Broken Arrow, OK 74012
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 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.
171 services171 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.
117 services117 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.
45 services45 patients

Medical Equipment Supplier Medicare DMEPOS 19

Medicare supplier enrollment and the product categories CVS Pharmacy #04896 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #04896

DMEPOS supplier · Broken Arrow, OKOperated by Oklahoma CVS Pharmacy LLC
✔

Accepts Medicare assignment

CVS Pharmacy #04896 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)20309165
Medicare Participant SinceJanuary 1, 2023
Supplier Location1853 S Aspen AveBroken Arrow, OK 74012
Phone(918) 251-9615
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 3

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

DR. KHA NGUYEN PHARMACIST
Pharmacist
1853 S ASPEN AVE
BROKEN ARROW, OK 74012
Tulsa County (918) 251-9615
LEWIS WAITS PHARM.D
Pharmacist
1853 S ASPEN AVE
BROKEN ARROW, OK 74012
Tulsa County (918) 251-9615
MARESA BOSHOFF PHARMACIST
Pharmacist
1853 S ASPEN AVE
BROKEN ARROW, OK 74012
Tulsa County (918) 251-9615

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 1073817185. It was assigned to this organization in the NPPES registry on January 4, 2011. The provider is doing business as CVS Pharmacy #04896.

Where is Oklahoma CVS Pharmacy LLC located?

Oklahoma CVS Pharmacy LLC is located at 1853 S Aspen Ave, Broken Arrow, OK 74012. The listed phone number is (918) 251-9615.

What is Oklahoma CVS Pharmacy LLC's specialty?

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

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

Yes. As a Medicare medical equipment supplier, CVS Pharmacy #04896 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 37D2223941) is associated with this NPI, valid through May 10, 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 Arizona Complete Health and 37 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 May 17, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.