Organization
GRAND ST PAUL CVS LLC
Active
Other names
CVS Pharmacy #16186
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
14546 DELLWOOD DR, BAXTER, MN 56425-9744
(218) 828-9219
(218) 828-9219
Mailing address
1 CVS DR, MAIL CODE 1090, 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
607982
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046823
PK
—
05
—
257560400
—
MN
Enumeration date
07/24/2006
Last updated
01/19/2023
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