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CVS PHARMACY #17217
NPI 1376585562
Pharmacy in Kernersville, NC

Active since June 12, 2006CLIA 34D2193873 · Waiver
1090 S MAIN ST, KERNERSVILLE, NC 27284(336) 992-1681(336) 992-1691 Get Directions Write a Review

NPPES record last updated: November 10, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 10, 2016, Jan 11, 2016 (2 updates tracked since 2016).

About Cvs Pharmacy #17217 NPPES

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

CVS PHARMACY #17217 (NPI 1376585562) is a healthcare organization registered as a pharmacy in Kernersville, North Carolina and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through September 24, 2028 and lists Susan Colbert, Sr. Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1376585562
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameNORTH CAROLINA CVS PHARMACY LLC
Location Address1090 S MAIN STKernersville, NC 27284-7440
Mailing Address1 Cvs Dr, Mail Code 1090Woonsocket, RI 02895-6146 · (401) 765-1500
Phone(336) 992-1681
Fax(336) 992-1691
Organization SubpartNo
Authorized OfficialSusan ColbertSr. Director, Payer Relations · (401) 770-2751
Enumeration DateJune 12, 2006
Last NPPES UpdateNovember 10, 20162 updates tracked since enumeration
✔ NPI 1376585562 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 09350 (NC)
1090 S MAIN ST, Kernersville, NC 27284
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Other Names 1

Doing Business AsCvs Pharmacy #17217

Other Identifiers 4

Medicaid0347323NC
Medicare NSC5640830366
Other2065865Pk
Medicare NSC0640711206

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 #17217 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 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
StateNorth CarolinaEnrollment IDO20161101000245DME · PharmacyDue dateDecember 31, 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 34D2193873

North Carolina CVS Pharmacy, LLC Dba CVS Pharmacy #3643 · Kernersville, NC
Active · expires Sep 24, 2028
CLIA Number34D2193873
Laboratory TypePharmacy
Certificate Effective DateSeptember 25, 2026
Certificate Expiration DateSeptember 24, 2028
Laboratory DirectorLisa Turner
Laboratory Phone(866) 389-2727
Laboratory LocationNorth Carolina CVS Pharmacy, LLC Dba CVS Pharmacy #36431398 Union Cross Rd, Kernersville, NC 27284
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.
115 services115 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.
80 services80 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.
28 services28 patients

Medical Equipment Supplier Medicare DMEPOS 19

Medicare supplier enrollment and the product categories CVS Pharmacy #17217 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #17217

DMEPOS supplier · Kernersville, NCOperated by North Carolina CVS Pharmacy LLC
✔

Accepts Medicare assignment

CVS Pharmacy #17217 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)20320859
Medicare Participant SinceJanuary 1, 2023
Supplier Location1090 S Main StKernersville, NC 27284
Phone(336) 992-1681
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. LAQUASHA P FOSTER PHARMD
Pharmacist
1090 S MAIN ST
KERNERSVILLE, NC 27284
Forsyth County (336) 992-1681
CAROLINA JUANICO CELA PHARMD
Pharmacist
1090 S MAIN ST
KERNERSVILLE, NC 27284
Forsyth County (336) 992-1681
DR. MATTHEW LOPATKA
Pharmacist
1090 S MAIN ST
KERNERSVILLE, NC 27284
Forsyth County (336) 992-1681
JESSE SHAW
Pharmacist
1090 S MAIN ST
KERNERSVILLE, NC 27284
Forsyth County (336) 992-1680

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 North Carolina CVS Pharmacy LLC's NPI number?

The NPI number for North Carolina CVS Pharmacy LLC is 1376585562. It was assigned to this organization in the NPPES registry on June 12, 2006. The provider is doing business as CVS Pharmacy #17217.

Where is North Carolina CVS Pharmacy LLC located?

North Carolina CVS Pharmacy LLC is located at 1090 S Main St, Kernersville, NC 27284. The listed phone number is (336) 992-1681.

What is North Carolina CVS Pharmacy LLC's specialty?

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

Is North Carolina CVS Pharmacy LLC enrolled in Medicare?

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

When is North Carolina CVS Pharmacy LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (North Carolina, Pharmacy) is due for revalidation by December 31, 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 North Carolina CVS Pharmacy LLC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, CVS Pharmacy #17217 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does North Carolina CVS Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2193873) is associated with this NPI, valid through September 24, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does North Carolina 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 31 other insurers list North Carolina 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 North Carolina CVS Pharmacy LLC was last updated on November 10, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.