Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy #16508
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
3300 124TH AVE NW, COON RAPIDS, MN 55433-3805
(763) 323-8402
(763) 354-1626
Mailing address
1 CVS DR, MAIL CODE 1090, 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
162319
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2044154
PK
—
05
—
359258800
—
MN
Enumeration date
07/26/2006
Last updated
11/15/2016
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