# MISSOURI CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \# 08563
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619911088
- **Authorized official:** CRISTIANA MAURICIO (MANAGER PHARMACY ENROLLMENTS)
- **Authorized official phone:** (401) 770-2937

## Contact information

- **Practice address:** 300 S COMMERCIAL ST., HARRISONVILLE, MO 64701-1282
- **Practice address phone:** (816) 380-6566
- **Practice address fax:** (816) 360-3826
- **Mailing address:** 1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

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

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 02/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2636744 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 602048605 | — | MO |
| 01 | — | 622048619 | DME | MO |