Active NPI
Missouri CVS Pharmacy, L.L.C.
Doing business as CVS Pharmacy #18052
- Community/Retail Pharmacy
- Fenton, MO
National Provider Identifier
1073098901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MISSOURI CVS PHARMACY, L.L.C.
- Doing business as
- CVS Pharmacy #18052
Schnucks Pharmacy 212 - Practice address
- 45 Gravois Bluffs Plaza Dr
Fenton, MO 63026-4012 - Phone
- (636) 343-5488
- Fax
- (636) 343-3851
- NPI assigned
- Sep 26, 2018
- Last updated
- Jun 29, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | NU | ||
| Medical Specialty Clinic/Center | 261QM2500X | NU | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
45 Gravois Bluffs Plaza Dr
Fenton, MO 63026-4012
Mailing address
1 CVS Drive
Box 1075
Woonsocket, RI 02895-6164
Phone (401) 765-1500
Other names 2
- CVS Pharmacy #18052
- Schnucks Pharmacy 212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061106000551 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 3577560499 | This NPI is an additional NPI on the enrollment |
| O20200803002294 | MO | DME Supplier - Pharmacy | 3577560499 | Practice locations: Fenton, MO |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharamcy #18052 | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Missouri CVS Pharmacy LLC
Organizations with this tax ID in the same state 22
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba CVS Pharmacy #18057
- Community/Retail Pharmacy
- Saint Louis, MO
- NPI 1013943539
-
dba CVS Pharmacy #18040
- Community/Retail Pharmacy
- Saint Louis, MO
- NPI 1023045465
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
45 Gravois Bluffs Plaza Dr
Fenton, MO 63026
Phone (636) 343-5488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1593388800000",
"number": "1073098901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DRIVE",
"address_2": "BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956164",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 GRAVOIS BLUFFS PLAZA DR",
"city": "FENTON",
"state": "MO",
"postal_code": "630264012",
"telephone_number": "636-343-5488",
"fax_number": "636-343-3851"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MISSOURI CVS PHARMACY, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2018-09-26",
"last_updated": "2020-06-29",
"certification_date": "2020-06-29",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #18052",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Schnucks Pharmacy 212",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.