Organization
SUPERVALU PHARMACIES INC
Active
Other names
CUB PHARMACY #1587
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA O'CONNELL (MANAGER, MANAGED CARE)
(651) 779-4023
Entity
Organization
Contact information
Practice address
4601 SNELLING AVE, MINNEAPOLIS, MN 55406-4464
(612) 886-3393
(612) 886-3850
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
—
0326790253
MEDICARE NSC
—
01
—
2434784
NCPDP
—
01
—
266013
PHARMACY STATE LICENSE
MN
Enumeration date
01/29/2020
Last updated
03/07/2023
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