Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy #07406
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
8468 TAMARACK BAY, WOODBURY, MN 55125
(651) 731-5177
Mailing address
1 CVS DR, BOX 1075 -PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
—
1013141001
—
MN
01
—
2429668
NCPDP
—
Enumeration date
05/06/2009
Last updated
03/07/2012
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