# MISSOURI CVS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#17553
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649402595
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 1040 NE CORONADO DR, BLUE SPRINGS, MO 64014-2971
- **Practice address phone:** (816) 622-3401
- **Practice address fax:** (816) 622-3411
- **Mailing address:** 1 CVS DR, 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 | — | — | — |
| 333600000X | Pharmacy | — | — | Yes |
| 3336C0003X | Community/Retail Pharmacy | 2009029218 | MO | — |

## Other

- **Enumeration date:** 08/11/2009
- **Last updated:** 10/26/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2121413 | PK | — |