Grand St Paul CVS LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

262487-9 Issued in MN

Legal business name

GRAND ST PAUL CVS LLC

Practice address

4241 Johnny Cake Ridge Rd
Eagan, MN 55122-2235

Phone

(651) 688-7041

NPI assigned

Sep 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Colbert

Title

Director, Payer Relations

Phone

(401) 770-2751

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• CVS PHARMACY #06715 Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Grand St Paul CVS Stores LLC121 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Grand St Paul CVS LLC

  • Pharmacy
  • Woodbury, MN
  • NPI 1013141001
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Otsego, MN
  • NPI 1023030707
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Coon Rapids, MN
  • NPI 1033131719
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Andover, MN
  • NPI 1033131727
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Moorhead, MN
  • NPI 1043232721
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Lino Lakes, MN
  • NPI 1043232739
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • St Louis Park, MN
  • NPI 1063512374
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Apple Valley, MN
  • NPI 1083784029
  NPD tax ID
• Grand St Paul CVS LLC

  • Community/Retail Pharmacy
  • Edina, MN
  • NPI 1093737769
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Stillwater, MN
  • NPI 1114949898
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Woodbury, MN
  • NPI 1124040803
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Savage, MN
  • NPI 1124040811
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1043310485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "PO BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 JOHNNY CAKE RIDGE RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222235",
            "telephone_number": "651-688-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ST PAUL CVS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "262487-9",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2426181",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #06715",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS PHARMACY #06715",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erica Gores, LAMFT
• Stephen T Gott, MD
• Rosie Marie Gourdine, PHLEBOTOMIST
• Julienna Danielle Graf
• Rebecca Graffdahl
• Grand St Paul CVS LLC
• Matthew William Grange, O.D.
• Rashaunacy Laree Grant
• Leah Beth Grau, APRN, CNP
• Jonathan Graves, D.C.

• Pharmacy in Eagan, MN
• Providers in Eagan, MN by specialty
• Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.