Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

264863 Issued in MN

Legal business name

SUPERVALU PHARMACIES INC

Doing business as

Cub Pharmacy

Practice address

1920 Buerkle Rd
White Bear Lake, MN 55110

Phone

(651) 777-2350

Fax

(651) 777-2537

NPI assigned

Oct 6, 2015

Last updated

Jun 20, 2018By 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

Steve McCann

Title

VP Pharmacy

Phone

(952) 828-4531

Specialties & licenses 2

Addresses

Other identifiers 3

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 5

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.

• Gretchen Gunderson

  • Pharmacist
  • White Bear Lake, MN
  • NPI 1538764725
  NPD (past)
• Nathan Lewis, PHARMD

  • Pharmacist
  • White Bear Lake, MN
  • NPI 1780289991
  NPD (past)
• Jason Moua, RPH

  • Pharmacist
  • White Bear Lake, MN
  • NPI 1871274803
  NPD (past)
• Jade Theisen, PHARMD, RPH

  • Pharmacist
  • White Bear Lake, MN
  • NPI 1821693953
  NPD (past)
• Lauren Bluhm, PHARMD

  • Pharmacist
  • Fairbanks, AK
  • NPI 1982290458
  NPD (past)

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1851761514",
    "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": "1920 BUERKLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55110",
            "telephone_number": "651-777-2350",
            "fax_number": "651-777-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "264863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851761514",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154664",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2432970",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CUB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suite Living Hospice Care, LLC
• Leif Per-Alden Sundberg, PA-C
• Margaret E Sundell, M.A., NCTMB
• Sunstone Counseling LLC
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Ellie Swallen
• Jacob Patrick Swallen
• Brenda Kay Sweet, BIRTH DOULA
• Ellen Patricia Swift, DDS
• Sydlewski Orthodontics (Signature Orthodontics)

• Community/Retail Pharmacy in White Bear Lake, MN
• Providers in White Bear Lake, 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.