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CVS PHARMACY
NPI 1174564041
Pharmacy in Kenosha, WI

Active since June 09, 2006CLIA 52D2224322 · Waiver
3726 22ND AVE, KENOSHA, WI 53140(262) 654-6545 Get Directions Write a Review

NPPES record last updated: February 27, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cvs Pharmacy NPPES

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

CVS PHARMACY (NPI 1174564041) is a healthcare organization registered as a pharmacy in Kenosha, Wisconsin and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through May 11, 2027 and lists Cristiana Mauricio, Manager Pharmacy Enrollments, as its authorized official.

NPPES Registry Identity

NPI1174564041
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWISCONSIN CVS PHARMACY LLC
Location Address3726 22ND AVEKenosha, WI 53140-5300
Mailing Address1 Cvs Dr, Po Box 1075Woonsocket, RI 02895-6146
Phone(262) 654-6545
Organization SubpartNo
Authorized OfficialCristiana MauricioManager Pharmacy Enrollments · (401) 770-2937
Enumeration DateJune 9, 2006
Last NPPES UpdateFebruary 27, 2008
✔ NPI 1174564041 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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 ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
3726 22ND AVE, Kenosha, WI 53140
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Other Names 1

Doing Business AsCvs Pharmacy

Other Identifiers 2

Other5129033Other Id Number-commercial Number
Medicare NSC5742910015

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 52D2224322

Wisconsin CVS Pharmacy LLC Dba CVS Pharmacy #08777 · Kenosha, WI
Active · expires May 11, 2027
CLIA Number52D2224322
Laboratory TypePharmacy
Certificate Effective DateMay 12, 2025
Certificate Expiration DateMay 11, 2027
Laboratory DirectorUtsavi Patel
Laboratory Phone(866) 389-2727
Laboratory LocationWisconsin CVS Pharmacy LLC Dba CVS Pharmacy #087773726 N 22nd St, Kenosha, WI 53140
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 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.
200 services197 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.
110 services110 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.
67 services67 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.
15 services15 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.
15 services15 patients

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.

CASSIDY ROCKEY PHARM D
Pharmacist
3726 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 654-6545
JACOB HENRICKSEN PHARMD
Pharmacist
3726 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 654-6545
UTSAVI PATEL
Pharmacist
3726 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 654-6545
BRANDON ORAWIEC
Pharmacist
3726 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 654-6545

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 Wisconsin CVS Pharmacy LLC's NPI number?

The NPI number for Wisconsin CVS Pharmacy LLC is 1174564041. It was assigned to this organization in the NPPES registry on June 9, 2006. The provider is doing business as CVS Pharmacy.

Where is Wisconsin CVS Pharmacy LLC located?

Wisconsin CVS Pharmacy LLC is located at 3726 22nd Ave, Kenosha, WI 53140. The listed phone number is (262) 654-6545.

What is Wisconsin CVS Pharmacy LLC's specialty?

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

Does Wisconsin CVS Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2224322) is associated with this NPI, valid through May 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wisconsin 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 35 other insurers list Wisconsin 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 Wisconsin CVS Pharmacy LLC was last updated on February 27, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.