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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1255816013
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	:	3740 MONTICELLO PLZ
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-8613
Country	:	US
Telephone Number	:	636-300-0629
Fax Number	:	636-329-0431

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	06/29/2020

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