Organization
GRAND ST PAUL CVS PHCY LLC
Active
Other names
CVS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIA MARINARO (PHCY ENROLLMENT REP)
(401) 765-1500
Entity
Organization
Contact information
Practice address
17578 DOOD BLVD, LAKEVILLE, MN 55044
(952) 432-8770
Mailing address
17578 DOOD BLVD, LAKEVILLE, MN 55044
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
262890
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2427690
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/03/2006
Last updated
08/22/2020
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