Supervalu Pharmacies Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUPERVALU PHARMACIES INC

Doing business as

Cub Pharmacy #1587

Practice address

4601 Snelling Ave
Minneapolis, MN 55406-4464

Phone

(612) 886-3393

Fax

(612) 886-3850

NPI assigned

Jan 29, 2020

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

Manager, Managed Care

Phone

(651) 779-4023

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• CUB PHARMACY #1587 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

Locations

Practitioners 3

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

• Ryan Larson

  • Pharmacist
  • Minneapolis, MN
  • NPI 1841043114
  NPD
• Dawn Scholbrock

  • Pharmacist
  • Minneapolis, MN
  • NPI 1316543432
  NPD
• Kristin Reddall, PHARM.D

  • Pharmacist
  • Minneapolis, MN
  • NPI 1255707311
  NPD (past)

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1942831839",
    "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": "4601 SNELLING AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554064464",
            "telephone_number": "612-886-3393",
            "fax_number": "612-886-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALU PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-29",
        "last_updated": "2023-03-07",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "O'CONNELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "MANAGER, MANAGED CARE",
        "authorized_official_telephone_number": "651-779-4023"
    },
    "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY STATE LICENSE",
            "identifier": "266013",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC",
            "identifier": "0326790253",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2434784",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUB PHARMACY #1587",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CUB PHARMACY #1587",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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)
• David A Supik, D.O.
• Morgan Supinski
• Supportive Housing and Managed Care Pilot (Hearth Connection)
• Supportive Housing and Managed Care Pilot (Hearth Connection)
• Supportive Housing and Managed Care Pilot (Hearth Connection)

• 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 Mar 7, 2023; 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.