NPIMap

Organization Active NPI

Missouri CVS Pharmacy, L.L.C.

Doing business as CVS Pharmacy #18043

  • Community/Retail Pharmacy
  • Bridgeton, MO
National Provider Identifier
1104852623
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MISSOURI CVS PHARMACY, L.L.C.
Doing business as
CVS Pharmacy #18043
Schnucks Pharmacy
Practice address
11253 Saint Charles Rock Rd
Bridgeton, MO 63044-2702
Phone
(314) 738-0235
Fax
(314) 738-0137
NPI assigned
Jun 25, 2006
Organization subpart
Yes
Parent organization
SCHNUCK MARKETS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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)CodeLicenseStatePrimary
Diabetes Educator Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WD0400X
Medical Specialty Clinic/Center 261QM2500X
Durable Medical Equipment & Medical Supplies 332B00000X 003851 MO
Pharmacy 333600000X 003851 MO
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

11253 Saint Charles Rock Rd
Bridgeton, MO 63044-2702

Mailing address

1 CVS Drive
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 2

IdentifierTypeStateIssuer
2618001OtherOTHER ID NUMBER-COMMERCIAL NUMBER
600125488MedicaidMO

Other names 2

  • CVS Pharmacy #18043 Doing business as
  • SCHNUCKS PHARMACY 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
O20200723003214 MO DME Supplier - Pharmacy 3577560499 Practice locations: Bridgeton, 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 #1804311253 Saint Charles Rock Rd, Bridgeton, MO 63044-2702(314) 738-0235 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 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
Part of
Schnucks Pharmacy

Organizations with this tax ID in the same state 24

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

View all 24

Member of 1

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

Locations

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

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1104852623",
    "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": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11253 SAINT CHARLES ROCK RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442702",
            "telephone_number": "314-738-0235",
            "fax_number": "314-738-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI CVS PHARMACY, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCHNUCK MARKETS INC",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "003851",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": "003851",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2618001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600125488",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #18043",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCHNUCKS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCHNUCKS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.

Verify at the official NPI Registry.