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General NPI Number Information
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NPI Number | 1215348727
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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 | 05/19/2014
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 17756 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044
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Country | US
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Telephone | 952-435-0542
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Fax | 952-435-2072
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Provider Business Mailing Address
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Address Line | 11840 VALLEY VIEW RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3643
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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 | VP PHARMACY
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Name | STEVE MCCANN
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Credential |
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Telephone | 952-828-4531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 264452
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License Number State | MN
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