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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 Pharmacy
2333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12636629OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1629012091
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI CVS PHARMACY LLC
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 : 315 W 75TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-5738
Country : US
Telephone Number : 816-361-4668
Fax Number :
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/16/2006
Last Update Date : 02/03/2015

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