Supervalu Pharmacies Inc
Organization Active NPI Community/Retail Pharmacy · Cambridge, MN
NPI 1487792495 · NPPES record last updated Oct 3, 2016
Key facts
- NPI
- 1487792495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 262965 (MN)
- Legal business name
- SUPERVALU PHARMACIES INC
- Practice address
- 100 Xylite St NE
Cambridge, MN 55008-5809 - Phone
- (763) 689-0185
- Fax
- (763) 689-0188
- NPI assigned
- Feb 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Aaron Sapp
- Title
- Director of Pharmacy Services
- Phone
- (952) 828-4026
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 262965 | MN | Yes |
Addresses
Primary practice location
100 Xylite St NE
Cambridge, MN 55008-5809
Mailing address
11840 Valley View Rd
Attn: Managed Care Pharmacy Dept.
Eden Prairie, MN 55344-3643
Phone (952) 828-4588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 833608000 | Medicaid | MN | |
| 2049183 | Other | PK |
Other names
- CUB PHARMACY
Other providers in Cambridge, MN
- Marcella Louise Stoeckel
- Maryann Michelle Stoeckel
- Madalyn Stoeckmann
- Denece Strandlund
- Alexa Stromberg
- Naomi Ruth Tague-Hamlin
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- The Winkley Company
- Dakota Rose Thesing
All providers in Cambridge, MN · Community/Retail Pharmacy in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.