MEDICARE: TARGET CORPORATION AND SUBSIDIARIES

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH1483	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2051384	OTHER		PK

General Provider Information

NPI Number	:	1205858800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET CORPORATION AND SUBSIDIARIES

Provider Business Mailing Address
First Line	:	1000 NICOLLET MALL # 1795
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	278 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2936
Country	:	US
Telephone Number	:	702-878-0400
Fax Number	:	702-570-4064

Authorized Official
Title or Position	:	HEALTHCARE ENROLLMENT SPECIALIST
Name	:	ROBYN STORTROEN
Credential	:
Telephone Number	:	612-696-8311

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/21/2014

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