Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY #1965
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA O'CONNELL (MANAGER, MANAGED CARE)
(651) 779-4023
Entity
Organization
Contact information
Practice address
900 CENTRAL AVE E, SAINT MICHAEL, MN 55376-4594
(763) 497-3568
(763) 497-3605
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326790254
MEDICARE NSC
—
01
—
2434859
NCPDP
—
01
—
266083
PHARMACY LICENSE
MN
Enumeration date
04/03/2020
Last updated
03/07/2023
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