MEDICARE: TARGET CORPORATION

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	3931	TN

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	2093976	OTHER		PK

General Provider Information

NPI Number	:	1366464018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET CORPORATION

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	:	5330 CANE RIDGE RD
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-3839
Country	:	US
Telephone Number	:	615-731-1729
Fax Number	:	615-932-5271

Authorized Official
Title or Position	:	HC ENROLLMENT SPECIALIST
Name	:	KIMBERLY JEROME
Credential	:
Telephone Number	:	612-696-8312

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/02/2015

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Directions to “TARGET CORPORATION ” Practice Location

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