Organization
GRAND ST. PAUL CVS LLC
Active
Other names
CVS Pharmacy # 04658
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR)
(401) 765-1500
Entity
Organization
Contact information
Practice address
7932 27TH AVE N, NEW HOPE, MN 55427-3401
(763) 544-3338
Mailing address
1 CVS DR, 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
—
1992081665
—
MN
01
—
2431120
NCPDP
MN
Enumeration date
10/26/2011
Last updated
03/08/2012
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