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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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy2004023122MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22632227OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1114026424
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI CVS PHARMACY, L.L.C.
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : PO BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 930 N BELT HWY
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64506-3013
Country : US
Telephone Number : 816-233-1353
Fax Number : 816-233-7635
Authorized Official
Title or Position : MGR PHCY ENROLLMENTS
Name : CRISTIANA MAURICIO
Credential :
Telephone Number : 401-770-2937
Provider Enumeration Date : 09/22/2006
Last Update Date : 02/03/2015

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