Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS PHARMACY #10902
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
30 FAIRVIEW AVE S, SAINT PAUL, MN 55105-1463
(651) 699-6008
Mailing address
1 CVS DR, BOX 1075, 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
—
1174065007
—
MN
01
—
2433364
NCPDP
MN
Enumeration date
11/09/2016
Last updated
04/04/2017
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