Organization Name: | GRAND ST. PAUL CVS LLC |
NPI Number: | 1679949028 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN F COLBERT (SR. DIRECTOR) |
Mailing Address: | 2312 Bemidji Ave North Bemidji |
State: | MN US |
Postal Code: | 56601 |
Phone Number: | 2187511626 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2015 |
NPI Last Update Date: | 12/17/2015 |
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 |