Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharnacy # 05616
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
329 FRAZEE ST E, DETROIT LAKES, MN 56501-3603
(218) 847-1484
Mailing address
1 CVS DR, P.O.BOX 1075-PHARMACY ENROLLMENTS, 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
—
1356619415
—
MN
01
—
2431144
NCPDP
MN
Enumeration date
12/05/2011
Last updated
01/17/2023
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