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NPI Code Detail

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

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
1163WD0400XDiabetes Educator Registered Nurse
2261QM2500XMedical Specialty Clinic/Center
3332B00000XDurable Medical Equipment & Medical Supplies002777MO
4333600000XPharmacy002777MO
53336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22601549OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1033154042
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI CVS PHARMACY, L.L.C.
Provider Business Mailing Address
First Line : 1 CVS DR # 1075
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 7450 HAMPTON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63109-3931
Country : US
Telephone Number : 314-832-3688
Fax Number : 314-832-3689
Authorized Official
Title or Position : SR. DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/17/2006
Last Update Date : 06/26/2020

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