NPIMap

Organization Active NPI

Missouri CVS Pharmacy LLC

Doing business as CVS Pharmacy #17887

  • Pharmacy
  • Saint Louis, MO
National Provider Identifier
1073361952
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MISSOURI CVS PHARMACY LLC
Doing business as
CVS Pharmacy #17887
Practice address
900 S Grand Blvd
Saint Louis, MO 63103-2918
Phone
(314) 405-6996
NPI assigned
May 7, 2024
Last updated
Jun 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan F Colbert
Title
Sr Director
Phone
(401) 765-1500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

900 S Grand Blvd
Saint Louis, MO 63103-2918

Mailing address

1 CVS Dr # 1075
Woonsocket, RI 02895
Phone (401) 765-1500

Other names 1

  • CVS Pharmacy #17887 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061106000551 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3577560499 This NPI is an additional NPI on the enrollment
O20240823001140 MO DME Supplier - Pharmacy 3577560499 Practice locations: Saint Louis, MO

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
CVS Pharmacy #17887900 S Grand Blvd, Saint Louis, MO 63103-2918(314) 405-6996 Immunosuppressive 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|Urological Supplies|Ent… Does not accept assignmentParticipating since Jan 1, 2025

National Provider Directory

National Provider Directory
Tax ID family
Missouri CVS Pharmacy LLC196 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations (25 of 236)

1253 Water Tower Pl
#18062
Arnold, MO 63010
Phone (636) 282-0591

3849 Vogel Rd
#16623
Arnold, MO 63010
Phone (636) 287-1339

3900 Vogel Rd
#18020
Arnold, MO 63010
Phone (636) 282-7555

1393 Big Bend Rd
#18035
Ballwin, MO 63021
Phone (636) 225-4633

14400 Clayton Rd
Ballwin, MO 63011
Phone (636) 207-1137

15025 Manchester Rd
#16006
Ballwin, MO 63011
Phone (636) 227-9436

15425 Manchester Rd
#18004
Ballwin, MO 63011
Phone (636) 256-7922

1106 E North Ave
#16868
Belton, MO 64012
Phone (816) 331-4325

1040 NE Coronado Dr
#17553
Blue Springs, MO 64014
Phone (816) 622-3401

1101 NW Woods Chapel Rd
Blue Springs, MO 64015
Phone (816) 224-3048

3201 S 7 Hwy
Blue Springs, MO 64014
Phone (816) 220-2302

1200 Branson Hills Pkwy
#17184
Branson, MO 65616
Phone (417) 243-4513

25 Brentwood Promenade Ct
#16476
Brentwood, MO 63144
Phone (314) 918-1939

8800 Manchester Rd
#18002
Brentwood, MO 63144
Phone (314) 962-0323

11253 Saint Charles Rock Rd
Bridgeton, MO 63044
Phone (314) 738-0235

11253 Saint Charles Rock Rd
#18043
Bridgeton, MO 63044
Phone (314) 738-0235

19 S Kingshighway
#18074
Cape Girardeau, MO 63703
Phone (573) 334-9125

202 Siemers Dr
Cape Girardeau, MO 63701
Phone (573) 334-6578

202 Siemers Dr
#16385
Cape Girardeau, MO 63701
Phone (573) 334-6578

2161 William St
Cape Girardeau, MO 63703
Phone (573) 380-6992

2161 William St
#10256
Cape Girardeau, MO 63703
Phone (573) 651-5264

1003 N US Highway 65
Carrollton, MO 64633
Phone (660) 542-1111

1003 N US Highway 65
#11311
Carrollton, MO 64633
Phone (660) 542-1111

1060 Woods Mill Plz
#18028
Chesterfield, MO 63017
Phone (636) 227-2770

1272 Town and Country Crossing Dr
#17069
Chesterfield, MO 63017
Phone (636) 591-0235

Practitioners & affiliated clinicians

Practitioners 184

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 184

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1073361952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR # 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "02895",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032918",
            "telephone_number": "314-405-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "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": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #17887",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS Pharmacy #17887",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; 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.

Verify at the official NPI Registry.