| Organization Name: | GRAND ST PAUL CVS LLC |
| NPI Number: | 1558566166 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN COLBERT (DIRECTOR, PAYER RELATIONS) |
| Mailing Address: | 21455 John Milless Drive Rogers |
| State: | MN US |
| Postal Code: | 55374 |
| Phone Number: | 7634282629 |
| Fax Number: | |
| NPI Enumeration Date: | 06/15/2007 |
| NPI Last Update Date: | 10/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |