MEDICARE: MISSOURI CVS PHARMACY, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	005829	MO
2	163WD0400X	Diabetes Educator Registered Nurse
3	261QM2500X	Medical Specialty Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies	005829	MO
5	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2629941	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619903960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI CVS PHARMACY, L.L.C.

Provider Business Mailing Address
First Line	:	1 CVS DRIVE
Second Line	:	BOX 1075
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:	314-994-4586

Provider Business Practice Location Address
First Line	:	1900 1ST CAPITOL DR
Second Line	:
City	:	ST. CHARLES
State	:	MO
Zip	:	63301-1609
Country	:	US
Telephone Number	:	636-946-0738
Fax Number	:	636-946-0775

Authorized Official
Title or Position	:	SR. DIRECTOR, PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/10/2020

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Directions to “MISSOURI CVS PHARMACY, L.L.C. ” Practice Location

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