Organization
GRAND ST PAUL CVS, LLC
Active
Other names
CVS PHARMACY # 06507
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
2420 DIVISION ST, ST. CLOUD, MN 56301
(320) 253-5366
Mailing address
1 CVS DRIVE, 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
—
1063759546
—
MN
01
—
2431740
NCPDP
MN
Enumeration date
01/03/2013
Last updated
04/12/2013
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