Organization
MISSOURI CVS PHARMACY LLC
Active
Other names
CVS Pharmacy #16558
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
17810 E 39TH ST S, INDEPENDENCE, MO 64055-3870
(816) 478-3645
(816) 698-5620
Mailing address
1 CVS DR, BOX 1075, 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
2015043639
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048126
PK
—
Enumeration date
07/24/2006
Last updated
11/21/2016
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