Healthcare Provider Details

I. General information

NPI: 1639110539
Provider Name (Legal Business Name): TARGET CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 ERNEST W BARRETT PKWY NW
KENNESAW GA
30144-6860
US

IV. Provider business mailing address

1039 NICOLLET AVE TPS1154
MINNEAPOLIS MN
55403-2404
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-6895
  • Fax: 770-425-6895
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAULA EKEREN
Title or Position: MANAGED CARE ADMIN SPEC
Credential:
Phone: 612-696-2262