Organization
GRAND ST. PAUL CVS, L.L.C.
Active
Other names
CVS Pharmacy # 05920
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
600 CENTRAL AVE. E, ST. MICHAEL, MN 55376-4584
(763) 497-6632
(401) 770-7108
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003118696
—
MN
01
—
2430469
NCPDP
MN
Enumeration date
12/02/2010
Last updated
07/11/2011
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