# MISSOURI CVS PHARMACY, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \#05645
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114026424
- **Authorized official:** CRISTIANA MAURICIO (MGR PHCY ENROLLMENTS)
- **Authorized official phone:** (401) 770-2937

## Contact information

- **Practice address:** 930 N BELT HWY, SAINT JOSEPH, MO 64506-3013
- **Practice address phone:** (816) 233-1353
- **Practice address fax:** (816) 233-7635
- **Mailing address:** 1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | 2004023122 | MO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 02/03/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2632227 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 601654502 | — | MO |