Grand St. Paul Cvs, L.l.c.

NPI #1043512031 in Dilworth, Minnesota

Provider Information

NPI Number: 1043512031
Entity Type: Organization
Organization Name: Grand St. Paul Cvs, L.l.c.
Primary Specialty: Pharmacy
Enumeration Date: Nov 23, 2010
Last Updated: May 6, 2011

Practice Location

Address: 1714 CENTER AVE W
City: Dilworth
State: Minnesota
ZIP Code: 56529-1330
Phone: (213) 287-5147

Authorized Official

Name: SUSAN COLBERT
Title: DIRECTOR, PAYER RELATIONS
Phone: (401) 765-1500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy	3336C0003X
Pharmacy	333600000X	Primary

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