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Contact Information

MISSOURI CVS PHARMACY LLC
300 KESTREL LANE
LAKE OZARK, MO65065
 Phone: 573-365-7298
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for MISSOURI CVS PHARMACY LLC

NPI Number 1649548330
LBN Legal business name MISSOURI CVS PHARMACY LLC
Authorized official SUSAN COLBERT - (DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/08/2011
Last updated 08/02/2012 - About 14 years ago
Identifiers
MO Medicaid 1649548330
Other 2639928 NCPDP
MO Other 1649548330 DME
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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