Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MCCANN (VP PHARMACY)
(952) 828-4531
Entity
Organization
Contact information
Practice address
1750 COUNTY ROAD 42 W, BURNSVILLE, MN 55337
(952) 892-6262
(952) 892-6183
Mailing address
421 3RD ST S, STILLWATER, MN 55082-4955
(651) 779-4023
(651) 779-2023
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
261660
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048082
PK
—
01
—
2423301
NCPDP
—
05
—
991324600
—
MN
Enumeration date
08/21/2006
Last updated
02/13/2024
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