Healthcare Provider Details

I. General information

NPI: 1255816013
Provider Name (Legal Business Name): MISSOURI CVS PHARMACY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 MONTICELLO PLZ
SAINT CHARLES MO
63304-8613
US

IV. Provider business mailing address

1 CVS DRIVE BOX 1075
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 636-300-0629
  • Fax: 636-329-0431
Mailing address:
  • Phone: 401-765-1500
  • Fax: 314-994-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN COLBERT
Title or Position: SR. DIRECTOR, PAYER RELATIONS
Credential:
Phone: 401-770-2751