NPIMap

Organization Active NPI

Missouri CVS Pharmacy LLC

  • Pharmacy
  • Springfield, MO
National Provider Identifier
1962742866
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MISSOURI CVS PHARMACY LLC
Practice address
3045 W Republic St
Springfield, MO 65807
Phone
(417) 889-0056
NPI assigned
Mar 1, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Susan Colbert
Title
Director
Phone
(401) 765-1500

Corporate family (same tax ID) 16

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.

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 #101513045 W Republic Rd, Springfield, MO 65807-4682(417) 889-0056 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

Medicare participation

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

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20061106000551 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3577560499 This NPI is an additional NPI on the enrollment
O20130516000196 MO DME Supplier - Pharmacy 3577560499 Practice locations: Springfield, MO

National Provider Directory

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

Specialties & licenses 3

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

Addresses

NPPES NPI Registry

Primary practice location

3045 W Republic St
Springfield, MO 65807

Mailing address

1 CVS Dr
Woonsocket, RI 02895-6146

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
1962742866MedicaidMO
2640969OtherNCPDP

Other names 1

NPPES NPI Registry
  • CVS Pharmacy# 10151 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 18, 2013.

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1962742866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 W REPUBLIC ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65807",
            "telephone_number": "417-889-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI CVS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-01",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962742866",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2640969",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy# 10151",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; 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.