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NPI Code Detail

MEDICARE: MISSOURI CVS PHARMACY LLC

MEDICARE: MISSOURI CVS PHARMACY LLC
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 Pharmacy2015043656MO
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12048825OTHERPK

General Provider Information

NPI Number : 1407878101
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI CVS PHARMACY LLC
Provider Business Mailing Address
First Line : 1 CVS DR
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 : 4250 RUSTY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63128-1973
Country : US
Telephone Number : 314-892-6428
Fax Number : 314-892-6428
Authorized Official
Title or Position : SR. DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 07/24/2006
Last Update Date : 09/30/2016

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Directions to “MISSOURI CVS PHARMACY LLC ” Practice Location

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