SUPERVALU PHARMACIES INC NPI 1558476697

NPI Information

  • NPI: 1558476697
  • Provider Name: SUPERVALU PHARMACIES INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: CUB PHARMACY
  • CLIA Number: 24D1026912
  • Address: 2013 W BROADWAY AVE
    FOREST LAKE, MN
    ZIP 55025
  • Phone: (651) 982-4603

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NPI Details

SUPERVALU PHARMACIES INC is a community/retail pharmacy pharmacy in Forest Lake, MN. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. SUPERVALU PHARMACIES INC NPI is 1558476697. The provider is registered as an organization entity type.
The provider Is Doing Business As Cub Pharmacy.

The provider's business location address is:

2013 W BROADWAY AVE
FOREST LAKE, MN
ZIP 55025-500
Phone: (651) 982-4603
Fax: (651) 982-4626

The provider's authorized official is Aaron Sapp .
The authorized official title is Director Of Pharmacy Services and has the following contact phone number (952) 828-4026.

The CLIA number assigned to this NPI record is 24D1026912 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/20/2006 and was last updated on 10/3/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy262112MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1166607000MEDICAIDMINNESOTA
22048257OTHERPK
30326790175MEDICARE NSC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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