Healthcare Provider Details

I. General information

NPI: 1568484269
Provider Name (Legal Business Name): TARGET CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 TOWER AVE
SUPERIOR WI
54880-5334
US

IV. Provider business mailing address

1000 NICOLLET MALL # 1795
MINNEAPOLIS MN
55403-2542
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-9876
  • Fax: 715-392-9876
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7361042
License Number StateWI

VIII. Authorized Official

Name: KIMBERLY JEROME
Title or Position: HC ENROLLMENT SPECIALIST
Credential:
Phone: 612-696-8312