Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

262341 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Practice address

23800 State Highway 7
Excelsior, MN 55331-3152

Phone

(952) 401-3990

Fax

(952) 401-3881

NPI assigned

Aug 20, 2006

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 3

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 8

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

• Tasha Bekkerus, PHARM.D.

  • Pharmacist
  • Excelsior, MN
  • NPI 1417269697
  NPD (past)
• Megan E Braband, PHARMD

  • Pharmacist
  • Shorewood, MN
  • NPI 1831795855
  NPD (past)
• Emily Hartman

  • Pharmacist
  • Shorewood, MN
  • NPI 1083200562
  NPD (past)
• John D. Hunter, RPH

  • Pharmacist
  • Shorewood, MN
  • NPI 1922219245
  NPD (past)
• Alyse Mackenzie Larson, PHARMD

  • Pharmacist
  • Shorewood, MN
  • NPI 1346845542
  NPD (past)
• Carlee Elizabeth Meehah, PHARMD

  • Pharmacist
  • Shorewood, MN
  • NPI 1700482445
  NPD (past)
• Jason Robert Reames, PHARM.D.

  • Pharmacist
  • Excelsior, MN
  • NPI 1750502258
  NPD (past)
• Allison Scott, PHARM.D.

  • Pharmacist
  • Shorewood, MN
  • NPI 1467893511
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1548375686",
    "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": "23800 STATE HIGHWAY 7",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313152",
            "telephone_number": "952-401-3990",
            "fax_number": "952-401-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048465",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "670122100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jack Andrew Steele, COTA/L
• Daniel J Stein, MD
• John Strandell, CRNA
• Emily Sundblad
• John Allen Sundquist, CMT
• Kevin Andrew Symms, CO, BOCPO
• Kerry Jean Taylor, MASSAGE THERAPIST
• TCM Wellness Clinic LLC
• Samantha Telega
• The Madison Center

• Community/Retail Pharmacy in Excelsior, MN
• Providers in Excelsior, 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.