Organization
GRAND ST. PAUL CVS, LLC.
Active
Other names
CVS PHARMACY # 05472
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F. COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
12751 NICOLLET AVE, BURNSVILLE, MN 55337-2890
(952) 736-8130
Mailing address
1 CVS DR, BOX 1075 PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
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
—
1841549557
—
MN
01
—
2431613
NCPDP
MN
Enumeration date
09/10/2012
Last updated
04/12/2013
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