Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MCCANN (VP PHARMACY)
(952) 828-4531
Entity
Organization
Contact information
Practice address
1021 15TH AVE SE, ROCHESTER, MN 55904
(507) 288-3234
(507) 288-8977
Mailing address
11840 VALLEY VIEW RD, EDEN PRAIRIE, MN 55344-3643
(952) 828-4588
(952) 947-3470
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
261996
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048203
PK
—
01
—
2424137
NCPDP
—
05
—
490610100
—
MN
Enumeration date
08/20/2006
Last updated
06/28/2023
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