# MISSOURI CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy\# 10193
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619318813
- **Authorized official:** SUSAN COLBERT (DIRECTOR)
- **Authorized official phone:** (401) 765-1500

## Contact information

- **Practice address:** 1550 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3408
- **Practice address phone:** (636) 639-1133
- **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:** 07/16/2013
- **Last updated:** 10/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1619318813 | — | MO |
| 01 | — | 2641226 | NCPDP | — |