Grand St Paul Cvs LLC

NPI #1952323644 in Rogers, Minnesota

Provider Information

NPI Number: 1952323644
Entity Type: Organization
Organization Name: Grand St Paul Cvs LLC
Primary Specialty: Pharmacy
Enumeration Date: Jul 24, 2006
Last Updated: Nov 15, 2016

Practice Location

Address: 21615 S DIAMOND LAKE RD
City: Rogers
State: Minnesota
ZIP Code: 55374-8893
Phone: (763) 428-6392

Authorized Official

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

Specialties & Taxonomy Codes

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

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