Organization
GRAND ST. PAUL CVS LLC
Active
Other names
CVS PHARMACY # 10756
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (SR. DIRECTOR)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2312 BEMIDJI AVE NORTH, BEMIDJI, MN 56601
(218) 751-1626
Mailing address
1 CVS DR, BOX 1075, 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
—
1679949028
—
MN
01
—
2432881
NCPDP
MN
Enumeration date
08/19/2015
Last updated
12/17/2015
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