CVS PHARMACY #09644
NPI 1619912516
Pharmacy in Hesperia, CA

Q: What is Garfield Beach CVS LLC's NPI number?

The NPI number for Garfield Beach CVS LLC is 1619912516. It was assigned to this organization in the NPPES registry on June 17, 2006. The provider is doing business as CVS Pharmacy #09644.

Q: What is Garfield Beach CVS LLC's specialty?

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

Active since June 17, 2006CLIA 05D2271489 · Waiver

16975 BEAR VALLEY RD, HESPERIA, CA 92345(760) 947-7043 Get Directions Write a Review

NPPES record last updated: November 19, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Cvs Pharmacy #09644 NPPES

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

CVS PHARMACY #09644 (NPI 1619912516) is a healthcare organization registered as a pharmacy in Hesperia, California and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through November 1, 2026 and lists Cristiana Mauricio, Manager Pharmacy Enrollments, as its authorized official.

NPPES Registry Identity

NPI1619912516

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameGARFIELD BEACH CVS LLC

Location Address16975 BEAR VALLEY RDHesperia, CA 92345-1809

Mailing Address1 Cvs Dr, Po Box 1075Woonsocket, RI 02895-6146

Phone(760) 947-7043

Organization SubpartNo

Authorized OfficialCristiana MauricioManager Pharmacy Enrollments · (401) 770-2937

Enumeration DateJune 17, 2006

Last NPPES UpdateNovember 19, 2009

✔ NPI 1619912516 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

16975 BEAR VALLEY RD, Hesperia, CA 92345

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Other Names 1

Doing Business AsCvs Pharmacy #09644

Other Identifiers 4

Other5621215Other Id Number-commercial Number

Medicare PINBQ784

OtherP00754218Medicare Rr

Medicare NSC5541620192

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 #09644 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 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

StateCaliforniaEnrollment IDO20080117000218Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateNovember 30, 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 05D2271489

Cvs/Pharmacy #09644 · Hesperia, CA

Active · expires Nov 1, 2026

CLIA Number05D2271489

Laboratory TypePharmacy

Certificate Effective DateNovember 2, 2024

Certificate Expiration DateNovember 1, 2026

Laboratory DirectorRachel G. Banales

Laboratory Phone(760) 947-7043

Laboratory LocationCvs/Pharmacy #0964416975 Bear Valley Rd, Hesperia, CA 92345

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 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.

101 services101 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.

63 services63 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.

32 services32 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.

22 services22 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.

19 services19 patients

Medical Equipment Supplier Medicare DMEPOS 18

Medicare supplier enrollment and the product categories CVS Pharmacy #09644 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy #09644

DMEPOS supplier · Hesperia, CAOperated by Garfield Beach CVS LLC

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Does not accept Medicare assignment

CVS Pharmacy #09644 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20436905

Medicare Participant SinceJanuary 1, 2019

Supplier Location16975 Bear Valley RdHesperia, CA 92345

Phone(760) 647-7043

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 7

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

MRS. JAN CAROL DECKER RPH

Pharmacist