Organization
MISSOURI CVS PHARMACY LLC
Active
Other names
CVS PHARMACY# 10118
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
501 W MOUNT VERNON ST, NIXA, MO 65714-9661
(417) 724-8409
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
—
1902144306
—
NE
01
—
2640882
NCPDP
—
Enumeration date
01/21/2013
Last updated
06/18/2013
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