Active NPI
Grand St Paul CVS LLC
Doing business as CVS Pharmacy # 00663
- Pharmacy
- Apple Valley, MN
National Provider Identifier
1083784029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 262915
- Legal business name
- GRAND ST PAUL CVS LLC
- Doing business as
- CVS Pharmacy # 00663
- Practice address
- 15051 Galaxie Ave
Apple Valley, MN 55124-6987 - Phone
- (952) 432-3535
- NPI assigned
- Nov 8, 2006
- Last updated
- Nov 18, 2010
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 262915 | MN | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
15051 Galaxie Ave
Apple Valley, MN 55124-6987
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS Pharmacy # 00663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930079361 | MN | DME Supplier - Pharmacy | 4688875156 | Practice locations: Apple Valley, MN |
| O20101103001135 | MN | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688875156 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Grand St Paul CVS LLC
Organizations with this tax ID in the same state 23
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1290038400000",
"number": "1083784029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15051 GALAXIE AVE",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551246987",
"telephone_number": "952-432-3535"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRAND ST PAUL CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-08",
"last_updated": "2010-11-18",
"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": "262915",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy # 00663",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Apple Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.