Organization
MISSOURI CVS PHARMACY LLC
Active
Other names
CVS PHARMACY# 06477
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
3002 HIGHWAY K, O FALLON, MO 63368-8675
(636) 272-5856
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
—
1073860490
—
MO
01
—
2640402
NCPDP
—
Enumeration date
08/06/2012
Last updated
01/28/2013
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