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Contact Information

MISSOURI CVS PHARMACY, L.L.C.
101 CIVIC CENTER DR
LAKE SAINT LOUIS, MO63367-3027
 Phone: 636-561-3963
 Fax: 636-561-5317
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Diabetes Educator

163WD0400X
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Medical Specialty

261QM2500X
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for MISSOURI CVS PHARMACY, L.L.C.

NPI Number 1255367504
LBN Legal business name MISSOURI CVS PHARMACY, L.L.C.
Authorized official SUSAN COLBERT - (SR. DIRECTOR, PAYER RELATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 06/25/2006
Last updated 06/26/2020 - About 6 years ago
Identifiers
MO License # 2004013648
MO Medicaid 606141109
Other 2635499 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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