# MISSOURI CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy\# 10152
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407196272
- **Authorized official:** SUSAN COLBERT (DIRECTOR)
- **Authorized official phone:** (401) 765-1500

## Contact information

- **Practice address:** 1501 E OHIO ST, CLINTON, MO 64735
- **Practice address phone:** (660) 890-0707
- **Mailing address:** 1 CVS DR, WOONSOCKET, RI 02895-6146

## Taxonomy

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

## Other

- **Enumeration date:** 02/15/2013
- **Last updated:** 06/18/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1407196272 | — | MO |
| 01 | — | 2640907 | NCPDP | — |