Provider Information for 1790884005
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GRAND ST PAUL CVS LLC
Other Names:Doing Business As:CVS PHARMACY #05992Organization Subpart: NO
NPI: 1790884005
Last Updated: 2010-11-19
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Details
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NPI | 1790884005 | ||||||||||||||||
Enumeration Date | 2006-09-22 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
Authorized Official Information | Name: SUSAN COLBERT Title: Director, Payer Relations Phone: 4017702751 | ||||||||||||||||
Mailing Address | 1 CVS DR PO BOX 1075 WOONSOCKET, RI 02895-6146 United States Phone: 401-765-1500 | Fax: | ||||||||||||||||
Primary Practice Address | 7901 BASS LAKE RD NEW HOPE, MN 55428-3105 United States Phone: 763-257-0130 | Fax: | ||||||||||||||||
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