CVS PHARMACY #04589
NPI 1477656247
Pharmacy in Grovetown, GA

Q: What is Georgia CVS Pharmacy, L.L.C.'s NPI number?

The NPI number for Georgia CVS Pharmacy, L.L.C. is 1477656247. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as CVS Pharmacy #04589.

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

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

Active since September 07, 2006CLIA 11D2255879 · Waiver

869 HORIZON SOUTH PKWY, GROVETOWN, GA 30813(706) 651-0306 Get Directions Write a Review

NPPES record last updated: March 7, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Cvs Pharmacy #04589 NPPES

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

CVS PHARMACY #04589 (NPI 1477656247) is a healthcare organization registered as a pharmacy in Grovetown, Georgia and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through March 17, 2028 and lists Susan F Colbert, Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1477656247

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameGEORGIA CVS PHARMACY, L.L.C.

Location Address869 HORIZON SOUTH PKWYGrovetown, GA 30813-3025

Mailing Address1 Cvs Dr, Po Box 1075Woonsocket, RI 02895-6146 · (401) 765-1500

Phone(706) 651-0306

Organization SubpartNo

Authorized OfficialSusan F ColbertDirector, Payer Relations · (401) 770-2751

Enumeration DateSeptember 7, 2006

Last NPPES UpdateMarch 7, 2012

✔ NPI 1477656247 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in GA · 007991

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

869 HORIZON SOUTH PKWY, Grovetown, GA 30813

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Other Names 1

Doing Business AsCvs Pharmacy #04589

Other Identifiers 5

Other1142669Other Id Number-commercial Number

Medicaid000700433BGA

Medicare NSC5754010107

Medicare PINP00962782GA

Medicare PIN202G738984

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 11D2255879

Georgia CVS Pharmacy, LLC Dba Cvs/Pharmacy #04589 · Grovetown, GA

Active · expires Mar 17, 2028

CLIA Number11D2255879

Laboratory TypePharmacy

Certificate Effective DateMarch 18, 2026

Certificate Expiration DateMarch 17, 2028

Laboratory DirectorBrandon Jump

Laboratory Phone(706) 651-0306

Laboratory LocationGeorgia CVS Pharmacy, LLC Dba Cvs/Pharmacy #04589869 Horizon South Parkway, Grovetown, GA 30813

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

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.

125 services125 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.

114 services114 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.

11 services11 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.

11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 18

Medicare supplier enrollment and the product categories CVS Pharmacy #04589 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #04589

DMEPOS supplier · Grovetown, GAOperated by Georgia CVS Pharmacy, L.L.C.

✔

Accepts Medicare assignment

CVS Pharmacy #04589 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)20318717

Medicare Participant SinceJanuary 1, 2023

Supplier Location869 Horizon South PkwyGrovetown, GA 30813

Phone(706) 651-0306

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 2

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

PHUNG KIM PHAN

Pharmacist

869 HORIZON SOUTH PKWY
GROVETOWN, GA 30813

Columbia County (706) 651-0306

DR. TAINASHIA PHILLIPS PHARMD

Pharmacist

869 HORIZON SOUTH PKWY
GROVETOWN, GA 30813

Columbia County (706) 651-0306

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 1477656247. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as CVS Pharmacy #04589.

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

Georgia CVS Pharmacy, L.L.C. is located at 869 Horizon South Pkwy, Grovetown, GA 30813. The listed phone number is (706) 651-0306.

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 #04589 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 11D2255879) is associated with this NPI, valid through March 17, 2028. 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 34 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 March 7, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.