Active NPI
Supervalu Pharmacies Inc
Doing business as Cub Pharmacy
- Community/Retail Pharmacy
- Brooklyn Center, MN
National Provider Identifier
1386759421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 261856
- Legal business name
- SUPERVALU PHARMACIES INC
- Doing business as
- Cub Pharmacy
- Practice address
- 3245 County Road 10
Brooklyn Center, MN 55429-3079 - Phone
- (763) 503-6810
- Fax
- (763) 503-6813
- NPI assigned
- Aug 20, 2006
- Last updated
- Oct 23, 2026
- 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
- Jessica O'Connell
- Title
- Sr. Manager, Managed Care
- Phone
- (651) 779-4023
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 261856 | MN | Primary |
Addresses
Primary practice location
3245 County Road 10
Brooklyn Center, MN 55429-3079
Mailing address
PO Box 990
Minneapolis, MN 55440-0990
Phone (651) 779-4023
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2048142 | Other | PK | |
| 382153600 | Medicaid | MN |
Other names 1
- CUB PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070919000434 | TX | Part B Supplier - Centralized Flu Biller | 2860472560 | This NPI is an additional NPI on the enrollment |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D1067667 | Cub Pharmacy #1925 | Certificate of waiver | Apr 23, 2027 |
National Provider Directory
National Provider DirectoryLocations
3245 County Road 10
Brooklyn Center, MN 55429
Phone (763) 503-6810
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Brooklyn Center, MN
- NPI 1912503004
-
- Pharmacist
- Brooklyn Center, MN
- NPI 1538764733
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1792713600000",
"number": "1386759421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 990",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554400990",
"telephone_number": "651-779-4023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 COUNTY ROAD 10",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554293079",
"telephone_number": "763-503-6810",
"fax_number": "763-503-6813"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUPERVALU PHARMACIES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-20",
"last_updated": "2026-10-23",
"certification_date": "2026-10-23",
"status": "A",
"authorized_official_last_name": "O'CONNELL",
"authorized_official_first_name": "JESSICA",
"authorized_official_title_or_position": "SR. MANAGER, MANAGED CARE",
"authorized_official_telephone_number": "651-779-4023"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MN",
"license": "261856",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2048142",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "382153600",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CUB PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2026; 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.