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	PH0011543	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1066605	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316969926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET CORPORATION AND SUBSIDIARIES

Provider Business Mailing Address
First Line	:	1000 NICOLLET MALL # 0910
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 TACOMA DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4555
Country	:	US
Telephone Number	:	727-841-7877
Fax Number	:	727-841-7877

Authorized Official
Title or Position	:	MANAGED CARE ADMINISTRATOR
Name	:	PAULA EKEREN
Credential	:
Telephone Number	:	612-696-2262

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/15/2008

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Directions to “TARGET CORPORATION AND SUBSIDIARIES ” Practice Location

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