Organization
MISSOURI CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY #05719
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
621 SW 3RD ST, LEES SUMMIT, MO 64063-2212
(816) 524-5084
(816) 524-0215
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
2004023146
MO
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2600282
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
600198816
—
MO
Enumeration date
09/25/2006
Last updated
02/03/2015
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