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NPI Code Detail

MEDICARE: SUPERVALU PHARMACIES INC

MEDICARE: SUPERVALU PHARMACIES INC
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
1333600000XPharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy262078MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12048240OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649385782
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERVALU PHARMACIES INC
Provider Business Mailing Address
First Line : 11840 VALLEY VIEW RD
Second Line : ATTN: MANAGED CARE PHARMACY DEPT.
City : EDEN PRAIRIE
State : MN
Zip : 55344-3643
Country : US
Telephone Number : 952-828-4588
Fax Number : 952-947-3470
Provider Business Practice Location Address
First Line : 4205 PHEASANT RIDGE DR NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4529
Country : US
Telephone Number : 763-784-0334
Fax Number : 763-784-0346
Authorized Official
Title or Position : DIRECTOR OF PHARMACY SERVICES
Name : AARON SAPP
Credential :
Telephone Number : 952-828-4026
Provider Enumeration Date : 08/20/2006
Last Update Date : 10/03/2016

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Directions to “SUPERVALU PHARMACIES INC ” Practice Location

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