Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy # 04573
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2650 RICE ST, LITTLE CANADA, MN 55113-2201
(651) 484-0504
(401) 770-7108
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
1265663991
—
MN
01
—
2429795
NCPDP
MN
Enumeration date
07/29/2009
Last updated
11/01/2018
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