MEDICARE: BADGER ACQUISITION OF MINNESOTA, 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
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1316985450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BADGER ACQUISITION OF MINNESOTA, 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 LAKE BREEZE AVE
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3844
Country	:	US
Telephone Number	:	763-259-0188
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR, PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/07/2019

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