MEDICARE: TARGET CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	5411418	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2022126	OTHER		PK

General Provider Information

NPI Number	:	1629090436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET CORPORATION

Provider Business Mailing Address
First Line	:	1000 NICOLLET MALL # 1795
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 E WEST RD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5414
Country	:	US
Telephone Number	:	708-730-3101
Fax Number	:	708-360-4339

Authorized Official
Title or Position	:	HC ENROLLMENT SPECIALIST
Name	:	KIMBERLY JEROME
Credential	:
Telephone Number	:	612-696-8312

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/04/2015

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