MISSOURI CVS PHARMACY, L.L.C. — NPI 1619219680 (Licensed & Credentialed Suppliers

CMS-1500 Box 24J / 33a • NPI

1619219680

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

333600000X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy

Box 32 Service Location & ZIP+4

124 W RUSSELL ST, IRONTON, MO, 63650-1313

✓ 9-Digit EDI 837 ZIP+4 (63650-1313)

Practice Phone & Referral Fax

(573) 546-0421

Fax: (573) 546-0491

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1619219680 (MISSOURI CVS PHARMACY, L.L.C.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1619219680` (NPI-2 Organization / Facility)
Provider / Legal Name	MISSOURI CVS PHARMACY, L.L.C.
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy NUCC Code: `333600000X` (Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	124 W RUSSELL ST, IRONTON, MO, 63650-1313
Practice Telephone / Fax	Tel: (573) 546-0421 \| Fax: (573) 546-0491
Administrative Mailing Address	1 CVS DR, WOONSOCKET, RI, 02895-6146
Enumeration & Last Sync	Enumerated: 2013-03-18 \| CMS Record Updated: 2017-12-20
Authorized Official	SUSAN COLBERT (Sr. Director, Payer Relations)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

124 W RUSSELL ST, IRONTON, MO, 63650-1313

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Plain-English Taxonomy & CMS Crosswalk (333600000X)

What Does Taxonomy Code 333600000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 333600000X translates to:
"Licensed & Credentialed Suppliers — Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MISSOURI CVS PHARMACY, L.L.C.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: N/A \| License: `Verified` \| Primary: Secondary
`3336C0003X` — Pharmacy, Community/Retail Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`333600000X` — Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MISSOURI CVS PHARMACY, L.L.C. (NPI #1619219680)