Organization
MISSOURI CVS PHARMACY, L.L.C.
Active
Other names
SCHNUCKS PHARMACY, CVS Pharmacy #18035
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1393 BIG BEND, BALLWIN, MO 63021-7601
(636) 225-4633
(636) 225-4634
Mailing address
1 CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
005834
MO
333600000X
Pharmacy
005834
MO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000043163
PTAN FOR MEDICARE IMMUNIZATIONS
—
01
—
2629890
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
600130744
—
MO
Enumeration date
06/20/2006
Last updated
06/26/2020
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