Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy #03562
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
8251 COLUMBINE RD., EDEN PRAIRIE, MN 55344
(952) 941-1266
Mailing address
1 CVS DR, BOX 1075- PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
01
—
2429214
NCPDP
—
05
—
362412100
—
MN
Enumeration date
09/03/2008
Last updated
06/25/2012
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