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CVS PHARMACY #06904
NPI 1750485587
Pharmacy in Tyler, TX

Active since September 12, 2006CLIA 45D2281341 · Waiver
4922 S BROADWAY AVE, TYLER, TX 75703(903) 561-6262(903) 534-0941 Get Directions Write a Review

NPPES record last updated: February 26, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Cvs Pharmacy #06904 NPPES

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

CVS PHARMACY #06904 (NPI 1750485587) is a healthcare organization registered as a pharmacy in Tyler, Texas and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through May 4, 2027 and lists Susan Colbert, Director, Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1750485587
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameCVS PHARMACY INC
Location Address4922 S BROADWAY AVETyler, TX 75703-1324
Mailing Address1 Cvs Dr, Po Box 1075Woonsocket, RI 02895-6146 · (401) 765-1500
Phone(903) 561-6262
Fax(903) 534-0941
Organization SubpartNo
Authorized OfficialSusan ColbertDirector, Payer Relations · (401) 770-2751
Enumeration DateSeptember 12, 2006
Last NPPES UpdateFebruary 26, 2015
✔ NPI 1750485587 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in TX · 24603
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
4922 S BROADWAY AVE, Tyler, TX 75703
Open in Google Maps ↗

Other Names 1

Doing Business AsCvs Pharmacy #06904

Other Identifiers 5

Other4536225Other Id Number-commercial Number
Medicare NSC1284730178
Medicare PINP00754740
Medicare PINPH0708
Medicaid000460774TX

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 45D2281341

CVS Pharmacy, Inc Dba Cvs/Pharmacy #06904 · Tyler, TX
Active · expires May 4, 2027
CLIA Number45D2281341
Laboratory TypePharmacy
Certificate Effective DateMay 5, 2025
Certificate Expiration DateMay 4, 2027
Laboratory DirectorHermes Ortiz
Laboratory Phone(903) 561-6262
Laboratory LocationCVS Pharmacy, Inc Dba Cvs/Pharmacy #069044922 S Broadway Ave, Tyler, TX 75703
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.
217 services216 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.
194 services194 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.
22 services22 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
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.
13 services13 patients

Medical Equipment Supplier Medicare DMEPOS 19

Medicare supplier enrollment and the product categories CVS Pharmacy # 06904 carries, from the Medicare DMEPOS supplier directory.

CVS Pharmacy # 06904

DMEPOS supplier · Tyler, TXOperated by CVS Pharmacy Inc
✔

Accepts Medicare assignment

CVS Pharmacy # 06904 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)20316881
Medicare Participant SinceJanuary 1, 2023
Supplier Location4922 S Broadway AveTyler, TX 75703
Phone(903) 561-6262
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.

KRISTEN MEIER LAWRENCE PHARMD
Pharmacist
4922 S BROADWAY AVE
TYLER, TX 75703
Smith County (903) 561-6262
DR. DUSTIN MEYERS PHARM.D.
Pharmacist
4922 S BROADWAY AVE
TYLER, TX 75703
Smith County (903) 561-6262
DR. HERMES JOSE ORTIZ PHARM D., R.PH
Pharmacist
4922 S BROADWAY AVE
TYLER, TX 75703
Smith County (903) 561-6262
DR. DONALD UCHENNA IRIELE RPH
Pharmacist
4922 S BROADWAY AVE
TYLER, TX 75703
Smith County (903) 561-6262

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 CVS Pharmacy Inc's NPI number?

The NPI number for CVS Pharmacy Inc is 1750485587. It was assigned to this organization in the NPPES registry on September 12, 2006. The provider is doing business as CVS Pharmacy #06904.

Where is CVS Pharmacy Inc located?

CVS Pharmacy Inc is located at 4922 S Broadway Ave, Tyler, TX 75703. The listed phone number is (903) 561-6262.

What is CVS Pharmacy Inc's specialty?

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

Does CVS Pharmacy Inc accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, CVS Pharmacy # 06904 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does CVS Pharmacy Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2281341) is associated with this NPI, valid through May 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does CVS Pharmacy Inc 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 41 other insurers list CVS Pharmacy Inc 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 CVS Pharmacy Inc was last updated on February 26, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.