# MISSOURI CVS PHARMACY, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#04850
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376863480
- **Authorized official:** SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 2715 E. BATTLEFIELD ST, SPRINGFIELD, MO 65804
- **Practice address phone:** (417) 888-0298
- **Mailing address:** 1 CVS DR, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

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

## Other

- **Enumeration date:** 06/11/2010
- **Last updated:** 02/03/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1376863480 | — | MO |
| 01 | — | 2639081 | NCPDP | — |