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Contact Information

MISSOURI CVS PHARMACY, L.L.C.
10070 GRAVOIS RD
SAINT LOUIS, MO63123-4024
 Phone: 314-631-6781
 Fax: 314-631-6782
 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 # 1629004973
LBN Legal business name MISSOURI CVS PHARMACY, L.L.C.
Authorized official SUSAN COLBERT - (SR. DIRECTOR, PAYER RELATIONS)
Entity Organization
Organization subpart 1 Yes
Enumeration date 06/25/2006
Last updated 06/26/2020 - About 6 years ago
Identifiers
MO License # 003944
MO Medicaid 601580707
Other 2618607 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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