Organization
MISSOURI CVS PHARMACY LLC
Active
Other names
CVS Pharmacy# 10417
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1153 E ELM ST, SPRINGFIELD, MO 65806-2612
(417) 831-0380
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
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
—
1891178844
—
MO
01
—
2642735
NCPDP
MO
Enumeration date
07/08/2015
Last updated
10/16/2015
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