Grand St Paul CVS LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

GRAND ST PAUL CVS LLC

Practice address

755 53Rd Ave NE
Fridley, MN 55421-1240

Phone

(763) 571-9766

Fax

(763) 852-0086

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Susan Colbert

Title

Sr. Director, Payer Relations

Phone

(401) 770-2751

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• CVS Pharmacy #17278 Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These 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

Tax ID family

Grand St Paul CVS Stores LLC121 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Grand St Paul CVS LLC

  • Pharmacy
  • Chanhassen, MN
  • NPI 1881793180
  NPD tax ID
• Grand St Paul CVS LLC

  • Community/Retail Pharmacy
  • Medina, MN
  • NPI 1881794196
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • North St Paul, MN
  • NPI 1902828676
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Apple Valley, MN
  • NPI 1922285956
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Owatonna, MN
  • NPI 1932121613
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • West Saint Paul, MN
  • NPI 1942471933
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Baxter, MN
  • NPI 1952323636
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Rogers, MN
  • NPI 1952323644
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Plymouth, MN
  • NPI 1952401390
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Duluth, MN
  • NPI 1952715096
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • Saint Paul, MN
  • NPI 1962424648
  NPD tax ID
• Grand St Paul CVS LLC

  • Pharmacy
  • White Bear Lake, MN
  • NPI 1972602274
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1972603280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "MAIL CODE 1090",
            "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": "755 53RD AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211240",
            "telephone_number": "763-571-9766",
            "fax_number": "763-852-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ST PAUL CVS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "SR. 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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262879",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182057500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049110",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #17278",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jamie Gordon, LICSW, LADC
• Jeffrey Dean Gordon, RPH
• Kayla Joan Gosnell, CNM
• Grace Home and Healthcare Inc
• Colleen B Gramling
• Marie Granquist
• Catherine M Gray, D.C.
• Elizabeth Joette Gray, MS, LADC
• Michelle Tiwalade Green Hightower, MD
• Erin Green

• Pharmacy in Fridley, MN
• Providers in Fridley, MN by specialty
• Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.