Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

263091 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Practice address

20250 Heritage Dr
Lakeville, MN 55044-6869

Phone

(952) 469-8404

Fax

(952) 469-8499

NPI assigned

Sep 20, 2007

Organization subpart

No

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

Authorized official

Name

Aaron Sapp

Title

Director of Pharmacy Services

Phone

(952) 828-4026

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• CUB PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deborah Ann Anderson, RPH

  • Pharmacist
  • Lakeville, MN
  • NPI 1306013099
  NPD (past)
• Andrea Bell, PHARM.D.

  • Pharmacist
  • Lakeville, MN
  • NPI 1346789617
  NPD (past)
• Lukas Tollefson, PHARMD

  • Pharmacist
  • Lakeville, MN
  • NPI 1487430781
  NPD (past)
• Melissa Catherine Vandermause, PHARMD

  • Pharmacist
  • Lakeville, MN
  • NPI 1154956332
  NPD (past)

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1265628515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11840 VALLEY VIEW RD",
            "address_2": "ATTN: MANAGED CARE PHARMACY DEPT.",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443643",
            "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": "20250 HERITAGE DR",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446869",
            "telephone_number": "952-469-8404",
            "fax_number": "952-469-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2016-10-03",
        "status": "A",
        "authorized_official_last_name": "SAPP",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY SERVICES",
        "authorized_official_telephone_number": "952-828-4026"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "930070000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Superior Home Care Nursing, LLC
• Superior Home Health Care 10603, LLC
• Superior Home Health Care, Incorporated
• Supervalu Pharmacies Inc
• Supervalu Pharmacies Inc
• Amy L Swanson, PHARM.D.
• Malakai Swanson
• Julia Swedberg, MA, LPC
• Hannah Swenson
• Alexis McKenzie Sylvester

• Community/Retail Pharmacy in Lakeville, MN
• Providers in Lakeville, 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 Oct 3, 2016; 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.