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General NPI Number Information
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NPI Number | 1992946446
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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 | 03/13/2009
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 10520 FRANCE AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3573
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Country | US
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Telephone | 952-888-4310
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Fax | 952-888-4453
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Provider Business Mailing Address
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Address Line | 11840 VALLEY VIEW RD ATTN: MANAGED CARE PHARMACY DEPT.
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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 | DIRECTOR OF PHARMACY SERVICES
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Name | AARON SAPP
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Credential |
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Telephone | 952-828-4026
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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 | 263360
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License Number State | MN
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