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	006511	MO
2	163WD0400X	Diabetes Educator Registered Nurse
3	261QM2500X	Medical Specialty Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies	006511	MO
5	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2632253	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740216266
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	:

Provider Business Practice Location Address
First Line	:	2073 WASHINGTON XING
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5285
Country	:	US
Telephone Number	:	636-239-4120
Fax Number	:	636-239-4125

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	:	06/29/2020

Similar Medicare Providers

1184100281 — ANDREA LYNN RATLIFF RPH
Practice Location Address:

2073 WASHINGTON XING
WASHINGTON, MO
63090-5285

Practice Phone: 636-239-4120
Practice Fax: 636-239-4125

1497633341 — JENNIFER LITTRELL FNP-C
Practice Location Address:

5285 S 400 E STE B
WASHINGTON TERRACE, UT
84405-7194

Practice Phone: 801-779-3500
Practice Fax: 801-779-3508

1528021052 — DR. MICHAIL CHARISSIS M.D.
Practice Location Address:

DILORENZO PENTAGON HEALTH CLINIC 5801 DEFENSE PENTAGON
WASHINGTON, DC
20310-5285

Practice Phone: 703-692-8878
Practice Fax:

1386680387 — DR. RON ZUIDERWEG D.O.
Practice Location Address:

5285 S 400 E STE B
WASHINGTON TERRACE, UT
84405-7194

Practice Phone: 801-779-3500
Practice Fax: 801-779-3508

1649205154 — GUY T COX CNM
Practice Location Address:

5285 S 400 E , SUITE B
WASHINGTON TERRACE, UT
84405-7194

Practice Phone: 801-476-7300
Practice Fax: 801-476-7307

1871513358 — JAVIER BIBB M.D.
Practice Location Address:

5285 S 400 E STE B
WASHINGTON TERRACE, UT
84405

Practice Phone: 801-779-3500
Practice Fax: 801-779-3508

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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.