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Organization
MISSOURI CVS PHARMACY LLC
Active
Organization
MISSOURI CVS PHARMACY LLC
Active
Other names
CVS PHARMACY 08236
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1301 S BELT HWY, SAINT JOSEPH, MO 64507-2228
(816) 901-0396
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730474230
—
MO
01
—
2639726
NCPDP
—
Enumeration date
06/13/2011
Last updated
12/12/2011
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