Grand St Paul Cvs LLC

NPI #1710005830 in Shakopee, Minnesota

Provider Information

NPI Number: 1710005830
Entity Type: Organization
Organization Name: Grand St Paul Cvs LLC
Primary Specialty: Pharmacy
Enumeration Date: Mar 27, 2007
Last Updated: Jun 22, 2012

Practice Location

Address: 4050 DEAN LAKE BLVD
City: Shakopee
State: Minnesota
ZIP Code: 55379
Phone: (952) 402-9039

Authorized Official

Name: SUSAN COLBERT
Title: DIRECTOR, PAYER RELATIONS
Phone: (401) 770-2751

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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