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Grand St Paul CVS Phcy LLC

Organization Active NPI Community/Retail Pharmacy · Lakeville, MN

NPI 1487748760 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1487748760
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
262890 (MN)
Legal business name
GRAND ST PAUL CVS PHCY LLC
Practice address
17578 Dood Blvd
Lakeville, MN 55044
Phone
(952) 432-8770
NPI assigned
Oct 3, 2006
Organization subpart
No

Authorized official

Name
Claudia Marinaro
Title
Phcy Enrollment Rep
Phone
(401) 765-1500

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Grand St Paul CVS Stores LLC (121 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 262890 MN Yes

Addresses

Primary practice location

17578 Dood Blvd
Lakeville, MN 55044

Mailing address

17578 Dood Blvd
Lakeville, MN 55044

Other identifiers

IdentifierTypeStateIssuer
2427690OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487748760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17578 DOOD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17578 DOOD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-432-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ST PAUL CVS PHCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARINARO",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "PHCY ENROLLMENT REP",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2427690",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeville, MN

All providers in Lakeville, MN · Community/Retail Pharmacy in Minnesota

Sources for this page

Verify at the official NPI Registry.