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General NPI Number Information
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NPI Number | 1184700049
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Entity Type | Organization
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Legal Business Name | SUPERVALU PHARMACIES INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 421 3RD ST S
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City | STILLWATER
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State | MN
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Zip | 55082-4955
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Country | US
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Telephone | 651-779-4023
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Fax | 651-779-2023
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Provider Business Mailing Address
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Address Line | PO BOX 776418
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City | CHICAGO
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State | IL
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Zip | 60677-6418
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Country | US
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Telephone | 952-828-4588
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Fax | 952-947-3470
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Authorized Official
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Title or Position | MANAGER, MANAGED CARE
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Name | JESSICA O'CONNELL
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Credential |
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Telephone | 651-779-4023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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