Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

260886 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Practice address

8015 Den Rd
Eden Prairie, MN 55344-4537

Phone

(952) 941-6728

Fax

(952) 944-5628

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 4

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

• Mariam Khalil, PHARMACIST

  • Pharmacist
  • Eden Prairie, MN
  • NPI 1407452519
  NPD (past)
• Sean McLister, PHARM.D.

  • Pharmacist
  • Eden Prairie, MN
  • NPI 1073821831
  NPD (past)
• Tuong Vy Pham, RPH

  • Pharmacist
  • Eden Prairie, MN
  • NPI 1588323307
  NPD (past)
• Debrae Schleeter, PHARMD.

  • Pharmacist
  • Eden Prairie, MN
  • NPI 1083955306
  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": "1851406995",
    "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": "8015 DEN RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553444537",
            "telephone_number": "952-941-6728",
            "fax_number": "952-944-5628"
        }
    ],
    "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": "260886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046901",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "998560300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Robert Sundin, D.C.
• Sunridge Autism Center LLC
• Superior Health LLC
• Superior Homes LLC
• Supervalu Inc
• Surecare Nemt Services LLC
• Joan H Sutcliffe, M.D.
• Devanie Sutter
• Sivkhaing Suy
• Alyson Swanson

• Community/Retail Pharmacy in Eden Prairie, MN
• Providers in Eden Prairie, 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.