Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS PHARMACY # 10252
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1411 VERMILLION, HASTINGS, MN 55033
(651) 438-2200
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
—
100042576
—
WI
05
—
1194126995
—
MN
01
—
2432627
NCPDP
MN
Enumeration date
09/11/2014
Last updated
02/12/2015
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