NPIMap

Missouri CVS Pharmacy, L.L.C

Organization Active NPI Pharmacy · Kirkwood, MO

NPI 1760933469 · NPPES record last updated Dec 20, 2016

Key facts

NPI
1760933469
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
MISSOURI CVS PHARMACY, L.L.C
Practice address
10820 Manchester Rd
Kirkwood, MO 63122
Phone
(314) 835-9448
NPI assigned
Oct 18, 2016
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2226045Missouri CVS Pharmacy, LLC Dba CVS/Pharmacy #10334
10820 Manchester Rd, Kirkwood, MO 63122		Certificate of waiverMay 25, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy # 10334
10820 Manchester Rd, Kirkwood, MO 63122-1208 · (314) 835-9448		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20061106000551 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3577560499 This NPI is an additional NPI on the enrollment
O20161209001063 MO DME Supplier - Pharmacy 3577560499 Practice locations: Kirkwood, MO

National Provider Directory

Tax ID family
Missouri CVS Pharmacy LLC (196 organizations share this tax ID)

Locations

10820 Manchester Rd
Saint Louis, MO 63122
Phone (314) 835-9448

Specialties & licenses

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

Addresses

Primary practice location

10820 Manchester Rd
Kirkwood, MO 63122

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1760933469MedicaidMO
NCPDPOtherMO2643713

Other names

  • CVS PHARMACY #10334 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2016.

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482192000000",
    "number": "1760933469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500",
            "fax_number": "401-770-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 MANCHESTER RD",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "63122",
            "telephone_number": "314-835-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI CVS PHARMACY, L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-12-20",
        "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": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760933469",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "2643713",
            "identifier": "NCPDP",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #10334",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkwood, MO

All providers in Kirkwood, MO · Pharmacy in Missouri

Sources for this page

Verify at the official NPI Registry.