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NPI Code Detail

MEDICARE: GRAND ST PAUL CVS LLC

MEDICARE: GRAND ST PAUL CVS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22433364OTHERMNNCPDP

General Provider Information

NPI Number : 1174065007
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND ST PAUL CVS LLC
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 30 FAIRVIEW AVE S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-1463
Country : US
Telephone Number : 651-699-6008
Fax Number :
Authorized Official
Title or Position : SR. DIRECTOR
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-765-1500
Provider Enumeration Date : 11/09/2016
Last Update Date : 04/04/2017

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