Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

264470 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Doing business as

CUB PHARMACY #1589

Practice address

7191 10TH St N
Oakdale, MN 55128

Phone

(651) 731-6247

Fax

(651) 739-6253

NPI assigned

May 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steve McCann

Title

VP Pharmacy

Phone

(952) 828-4531

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• CUB PHARMACY #1589 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

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1558772194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11840 VALLEY VIEW RD",
            "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": "7191 10TH ST N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "55128",
            "telephone_number": "651-731-6247",
            "fax_number": "651-739-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-16",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "VP PHARMACY",
        "authorized_official_telephone_number": "952-828-4531"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "264470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558772194",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146384",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2432475",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY #1589",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CUB PHARMACY #1589",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Justina Stich, MA, LPCC
• Strategic Practice Management, P.a.
• Brent Stuart
• Charilyn Suggs
• Michael Sulzbach, PHARM.D.
• Dawn Surman, LMFT
• Heather Renee Swanson-Juvera, MAOTR/L
• Ruth Marie Swartwood, PH.D., L.P
• Elizabeth Ann Swope, NP
• Lydia Sydlewski

• Community/Retail Pharmacy in Oakdale, MN
• Providers in Oakdale, 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 Jun 20, 2018; 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.