NPIMap

Grand St. Paul CVS LLC

Organization Active NPI Pharmacy · Bloomington, MN

NPI 1497042899 · NPPES record last updated Mar 7, 2012

Key facts

NPI
1497042899
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
GRAND ST. PAUL CVS LLC
Practice address
8936 Lyndale Ave S
Bloomington, MN 55420-2742
Phone
(401) 765-1500
NPI assigned
Jul 6, 2011
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Director, Payer Relations
Phone
(401) 765-1500

Corporate family (same tax ID) 24

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #03060
8936 Lyndale Ave S, Bloomington, MN 55420-2742 · (952) 881-0163		 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Does not accept assignment
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20101103001135 MN Part B Supplier - Mass Immunization (Roster Biller Only) 4688875156 This NPI is an additional NPI on the enrollment
O20111201000124 MN DME Supplier - Pharmacy 4688875156 Practice locations: Bloomington, MN

National Provider Directory

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

Locations

8936 Lyndale Ave S
Minneapolis, MN 55420
Phone (952) 881-0163

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

8936 Lyndale Ave S
Bloomington, MN 55420-2742

Mailing address

1 CVS Dr
P.O. Box 1075-Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
1497042899MedicaidMN
2430914OtherNCPDP

Other names

  • CVS Pharmacy # 03060 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 Mar 7, 2012.

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1497042899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "P.O. BOX 1075-PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500",
            "fax_number": "401-770-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8936 LYNDALE AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554202742",
            "telephone_number": "401-765-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ST. PAUL CVS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497042899",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2430914",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy # 03060",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, MN

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Sources for this page

Verify at the official NPI Registry.