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
5370 16TH AVE, ST LOUIS PARK, MN 55416
(952) 544-0542
(952) 544-0629
Mailing address
11840 VALLEY VIEW RD, EDEN PRAIRIE, MN 55344-3643
(952) 828-4588
(952) 947-3470
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
264447
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760893374
—
MN
01
—
2146373
PK
—
01
—
2432386
NCPDP
—
Enumeration date
05/16/2014
Last updated
06/20/2018
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