Organization
MISSOURI CVS PHARMACY, L.L.C.
Active
Other names
CVS PHARMACY #05724
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANA MAURICIO (MGR PHCY ENROLLMENTS)
(401) 770-2937
Entity
Organization
Contact information
Practice address
13101 STATE LINE RD, KANSAS CITY, MO 64145-1650
(816) 942-2438
(816) 942-2473
Mailing address
1 CVS DR, PO BOX 1075, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2004023132
MO
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2635285
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
606103000
—
MO
Enumeration date
09/22/2006
Last updated
02/03/2015
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