Active NPI
Grand St Paul CVS LLC
Doing business as CVS Pharmacy #07175
- Pharmacy
- White Bear Lake, MN
National Provider Identifier
1972602274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 262578-4
- Legal business name
- GRAND ST PAUL CVS LLC
- Doing business as
- CVS Pharmacy #07175
- Practice address
- 4800 Highway 61 N
White Bear Lake, MN 55110-2844 - Phone
- (651) 762-3864
- NPI assigned
- Sep 22, 2006
- Last updated
- Mar 7, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 262578-4 | MN | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4800 Highway 61 N
White Bear Lake, MN 55110-2844
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS PHARMACY #07175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930046609 | MN | DME Supplier - Pharmacy | 4688875156 | Practice locations: White Bear Lake, MN |
| O20101103001135 | MN | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688875156 | This NPI is an additional NPI on the enrollment |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #07175 | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Grand St Paul CVS Phcy LLC
Organizations with this tax ID in the same state 14
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to 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.
-
- Pharmacist
- White Bear Lake, MN
- NPI 1366047235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1331078400000",
"number": "1972602274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 HIGHWAY 61 N",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551102844",
"telephone_number": "651-762-3864"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRAND ST PAUL CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-22",
"last_updated": "2012-03-07",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MN",
"license": "262578-4",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY #07175",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in White Bear Lake, MN
- Mikhail Golben, DPT
- Golden Elderly Care Suites LLC
- Jenna Rose Goldsmith, DC
- Katerina Goncharuk, PHARD
- Grand St Paul CVS LLC (CVS Pharmacy # 01776)
- Jennifer Ann Vermeer Gregor, M.S.W., L.I.C.S.W.
- Olivia Grev, NP
- Emmah Kaye Griswold, PA-C
- Kadi Groppoli
- Group Health, Inc. (HealthPartners White Bear Dental Clinic)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.