Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB Pharmacy 1592
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MCCANN (VP PHARMACY)
(952) 828-4531
Entity
Organization
Contact information
Practice address
10881 UNIVERSITY AVE NE, BLAINE, MN 55434
(763) 767-8271
(763) 772-0871
Mailing address
11840 VALLEY VIEW RD, EDEN PRAIRIE, MN 55344-3643
(952) 828-4588
(952) 947-3470
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
265185
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326790251
MEDICARE NSC
—
01
—
2164696
PK
—
01
—
2433338
NCPDP
—
Enumeration date
10/28/2016
Last updated
06/20/2018
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