Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

264446 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Doing business as

Cub Pharmacy

Practice address

1104 Lagoon Ave
Minneapolis, MN 55408-2059

Phone

(612) 825-1992

Fax

(612) 825-1996

NPI assigned

May 16, 2014

Last updated

Oct 23, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessica O'Connell

Title

Sr Manager, Managed Care

Phone

(651) 779-4023

Specialties & licenses 1

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

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792713600000",
    "number": "1598176117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 990",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400990",
            "telephone_number": "651-779-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 LAGOON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082059",
            "telephone_number": "612-825-1992",
            "fax_number": "612-825-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-16",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A",
        "authorized_official_last_name": "O'CONNELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "SR MANAGER, MANAGED CARE",
        "authorized_official_telephone_number": "651-779-4023"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "264446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598176117",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146376",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catalina Sunwoo, NP
• Savy Suos, RN, BSN
• Jennifer Lynn Super, RD LD
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy #1587)
• David A Supik, D.O.

• Community/Retail Pharmacy in Minneapolis, MN
• Providers in Minneapolis, 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 23, 2026; 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.