Organization
SUPERVALU PHARMACIES INC
Active
Parent organization
SUPERVALU INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUPERVALU INC
Authorized official
JESSICA O'CONNELL (MANAGER, MANAGED CARE)
(651) 779-4023
Entity
Organization
Contact information
Practice address
421 3RD ST S, STILLWATER, MN 55082-4955
(651) 779-4023
(651) 779-2023
Mailing address
PO BOX 776418, CHICAGO, IL 60677-6418
(952) 828-4588
(952) 947-3470
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00418313
RAILROAD MEDICARE PTAN
—
Enumeration date
10/31/2006
Last updated
04/26/2024
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