# MISSOURI CVS PHARMACY, L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#11407
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427043413
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 805 N KENTUCKY AVE, SUITE 2, WEST PLAINS, MO 65775-2045
- **Practice address phone:** (417) 256-2274
- **Mailing address:** 1 CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 005315 | MO | Yes |

## Other

- **Enumeration date:** 09/15/2005
- **Last updated:** 06/26/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 600305510 | — | MO |