# SUPERVALU PHARMACIES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CUB PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538274667
- **Authorized official:** AARON SAPP (DIRECTOR OF PHARMACY SERVICES)
- **Authorized official phone:** (952) 828-4026

## Contact information

- **Practice address:** 1512 SW ROUTE 26, FREEPORT, IL 61032
- **Practice address phone:** (815) 297-0881
- **Practice address fax:** (815) 297-0972
- **Mailing address:** 11840 VALLEY VIEW RD, ATTN: MANAGED CARE PHARMACY DEPT., EDEN PRAIRIE, MN 55344-3643
- **Mailing address phone:** (952) 828-4588
- **Mailing address fax:** (952) 947-3470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 54014383 | IL | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 10/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2020722 | PK | — |