NPIMap

Organization Active NPI

Supervalu Pharmacies Inc

Doing business as Cub Specialty Pharmacy #1964

  • Community/Retail Pharmacy
  • Stillwater, MN
National Provider Identifier
1740635770
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
265075 Issued in MN
Legal business name
SUPERVALU PHARMACIES INC
Doing business as
Cub Specialty Pharmacy #1964
Supervalu Pharmacies Specialty Services
Practice address
421 3Rd St S
Stillwater, MN 55082-4955
Phone
(651) 439-0557
Fax
(651) 439-0637
NPI assigned
Apr 27, 2016
Last updated
Dec 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Authorized official

Name
Aaron SappNPI 1255450821
Title
Director of Pharmacy Services
Phone
(952) 828-4026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 265075 MN Primary

Addresses

Primary practice location

421 3Rd St S
Stillwater, MN 55082-4955

Mailing address

421 3Rd St S
Stillwater, MN 55082-4955
Phone (651) 779-4023

Other identifiers 1

IdentifierTypeStateIssuer
2159821OtherPK

Other names 2

  • CUB SPECIALTY PHARMACY #1964 Doing business as
  • SUPERVALU PHARMACIES SPECIALTY SERVICES Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cub Pharmacy 6242 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703203200000",
    "number": "1740635770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 3RD ST S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550824955",
            "telephone_number": "651-779-4023",
            "fax_number": "651-779-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 3RD ST S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550824955",
            "telephone_number": "651-439-0557",
            "fax_number": "651-439-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "265075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159821",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB SPECIALTY PHARMACY #1964",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SUPERVALU PHARMACIES SPECIALTY SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.