Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA O'CONNELL (MANAGER MANAGED CARE)
(952) 828-4588
Entity
Organization
Contact information
Practice address
1200 S RIVERFRONT DR, MANKATO, MN 56001-2484
(507) 446-2524
(507) 387-6996
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
262027
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171657300
—
MN
01
—
2048235
PK
—
Enumeration date
08/21/2006
Last updated
02/16/2017
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