Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy # 03313
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1471 ROBERT ST S, WEST SAINT PAUL, MN 55118-3141
(651) 552-6029
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, 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
01
—
2428779
NCPDP#
MN
05
—
653463000
—
MN
Enumeration date
03/18/2008
Last updated
11/17/2022
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