Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS PHARMACY # 10397
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
25 2ND ST NE, AITKIN, MN 56431-1419
(218) 927-3754
Mailing address
1 CVS DR, P.O. 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
05
—
1598101362
—
MN
01
—
2431966
NCPDP
MN
Enumeration date
05/20/2013
Last updated
10/21/2013
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