# GRAND ST PAUL CVS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#17503
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629226626
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 875 E MAIN ST, WACONIA, MN 55387-1081
- **Practice address phone:** (952) 442-9334
- **Practice address fax:** (952) 442-9343
- **Mailing address:** 1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | 263240 | MN | — |

## Other

- **Enumeration date:** 09/03/2008
- **Last updated:** 11/21/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2116799 | PK | — |
| 05 | — | 896477000 | — | MN |