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Contact Information

SUPERVALU PHARMACIES INC
8150 WEDGEWOOD LN N
MAPLE GROVE, MN55369
 Phone: 763-494-8355
 Fax: 763-494-8358
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SUPERVALU PHARMACIES INC

NPI # 1679688717
LBN Legal business name SUPERVALU PHARMACIES INC
Authorized official STEVE MCCANN - (VP PHARMACY)
Entity Organization
Organization subpart 1 No
Enumeration date 08/20/2006
Last updated 06/20/2018 - About 8 years ago
Identifiers
MN License # 261058
MN Medicaid 241320500
Other 2421054 NCPDP
Other 2047023 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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