CVS PHARMACY #04531
NPI 1619070448
Pharmacy in Jackson, GA

Q: What is Georgia CVS Pharmacy LLC's NPI number?

The NPI number for Georgia CVS Pharmacy LLC is 1619070448. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as CVS Pharmacy #04531.

Q: What is Georgia CVS Pharmacy LLC's specialty?

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

Active since September 07, 2006CLIA 11D2281435 · Waiver

506 E 3RD ST, JACKSON, GA 30233(770) 775-7137 Get Directions Write a Review

NPPES record last updated: January 17, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About Cvs Pharmacy #04531 NPPES

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

CVS PHARMACY #04531 (NPI 1619070448) is a healthcare organization registered as a pharmacy in Jackson, Georgia and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through May 7, 2027 and lists Susan F Colbert, Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1619070448

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameGEORGIA CVS PHARMACY LLC

Location Address506 E 3RD STJackson, GA 30233-2105

Mailing Address1 Cvs DrWoonsocket, RI 02895-6146 · (401) 765-1500

Phone(770) 775-7137

Organization SubpartNo

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

Enumeration DateSeptember 7, 2006

Last NPPES UpdateJanuary 17, 2023

NPPES CertifiedJanuary 17, 2023

✔ NPI 1619070448 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in GA · 006686

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

506 E 3RD ST, Jackson, GA 30233

Open in Google Maps ↗

Other Names 1

Doing Business AsCvs Pharmacy #04531

Other Identifiers 2

Other1130450Other Id Number-commercial Number

Medicaid000328875BGA

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 11D2281435

Georgia CVS Pharmacy, LLC Dba CVS Pharmacy #04531 · Jackson, GA

Active · expires May 7, 2027

CLIA Number11D2281435

Laboratory TypePharmacy

Certificate Effective DateMay 8, 2025

Certificate Expiration DateMay 7, 2027

Laboratory DirectorKenneth Amayo

Laboratory Phone(770) 775-7134

Laboratory LocationGeorgia CVS Pharmacy, LLC Dba CVS Pharmacy #04531506 East 3rd Street, Jackson, GA 30233

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.

80 services80 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.

57 services57 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.

21 services21 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.

17 services17 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.

16 services16 patients

Medical Equipment Supplier Medicare DMEPOS 18

Medicare supplier enrollment and the product categories CVS Pharmacy #04531 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #04531

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

✔

Accepts Medicare assignment

CVS Pharmacy #04531 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)20318753

Medicare Participant SinceJanuary 1, 2023

Supplier Location506 E 3rd StJackson, GA 30233

Phone(770) 775-7134

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.

VICKLYN LUNICK DATILUS PHARMD

Pharmacist

506 E 3RD ST
JACKSON, GA 30233

Butts County (770) 775-7134

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 LLC's NPI number?

The NPI number for Georgia CVS Pharmacy LLC is 1619070448. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as CVS Pharmacy #04531.

Where is Georgia CVS Pharmacy LLC located?

Georgia CVS Pharmacy LLC is located at 506 E 3rd St, Jackson, GA 30233. The listed phone number is (770) 775-7137.

What is Georgia CVS Pharmacy LLC's specialty?

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

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

Yes. As a Medicare medical equipment supplier, CVS Pharmacy #04531 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Georgia CVS Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2281435) is associated with this NPI, valid through May 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Georgia 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 34 other insurers list Georgia 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 Georgia CVS Pharmacy LLC was last updated on January 17, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.