Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA O'CONNELL (MANGER, MANAGED CARE)
(952) 828-4588
Entity
Organization
Contact information
Practice address
1177 CLARENCE ST, SAINT PAUL, MN 55106-2809
(651) 774-7772
(651) 774-7799
Mailing address
11840 VALLEY VIEW RD, ATTN: MANAGED CARE PHARMACY DEPT., 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
263254
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2116850
PK
—
05
—
851930000
—
MN
Enumeration date
09/04/2008
Last updated
02/20/2017
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