Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUPERVALU PHARMACIES INC

Practice address

421 3Rd St S
Stillwater, MN 55082-4955

Phone

(651) 779-4023

Fax

(651) 779-2023

NPI assigned

Oct 31, 2006

Last updated

Apr 26, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

SUPERVALU INCAs reported in NPPES

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

Authorized official

Name

Jessica O'Connell

Title

Manager, Managed Care

Phone

(651) 779-4023

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Cub Pharmacy 6242 organizations share this tax ID, including this one

Part of

Supervalu Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Supervalu Pharmacies Inc

  dba Cub Specialty Pharmacy #1964

  • Community/Retail Pharmacy
  • Stillwater, MN
  • NPI 1740635770
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Supervalu Inc

  • Community/Retail Pharmacy
  • Eden Prairie, MN
  • NPI 1659457141
  NPPES parent name

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1184700049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776418",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776418",
            "telephone_number": "952-828-4588",
            "fax_number": "952-947-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 3RD ST S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550824955",
            "telephone_number": "651-779-4023",
            "fax_number": "651-779-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUPERVALU INC",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "O'CONNELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "MANAGER, MANAGED CARE",
        "authorized_official_telephone_number": "651-779-4023"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00418313",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Ann Strohbehn, MD
• Barry Robert Stromberg, DOS
• Jennifer Ann Stubblefield
• Tehya Studie
• Sun Trad Chin Acu MN LLC (Sunshine Traditional Chinese Acupuncture)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Specialty Pharmacy #1964)
• Sarah Ashley Swanberg, MS, LPCC
• Katherine Swanson, D.O.
• Kianna Swanson, OD

• Community/Retail Pharmacy in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; 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.

Verify at the official NPI Registry.