Organization
GRAND ST PAUL CVS LLC
Active
Other names
TARGET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3800 LEXINGTON AVE N, SHOREVIEW, MN 55126-2916
(651) 486-0649
(651) 234-3013
Mailing address
1 CVS DR, MAIL CODE 1090, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
437804
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097860400
—
MN
01
—
2046873
PK
—
Enumeration date
07/24/2006
Last updated
01/11/2016
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