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Export Provider Record NPI 1003921149
Supervalu Pharmacies Inc
Organization Subpart: NO
Active
NPI Number1003921149
NPI TypeNPI-2 Organization
SpecialtyPharmacy, Community/Retail Pharmacy
Provider Details
NPI1003921149
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2006-08-20
Last Updated2023-06-28
Authorized OfficialSteve Mccann
VP Pharmacy
Phone: 9528284531
Mailing Address11840 Valley View Rd
Eden Prairie, MN 55344-3643
United States
Phone: (952) 828-4588 | Fax: (952) 947-3470
📍 View Map
Primary Practice Address1021 15th Ave Se
Rochester, MN 55904
United States
Phone: (507) 288-3234 | Fax: (507) 288-8977
📍 View Map
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2048203PK
Other (non-Medicare)2424137NCPDP
MEDICAIDMN490610100
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
No332B00000X – Durable Medical Equipment & Medical Supplies
No333600000X – Pharmacy
Yes3336C0003X – Pharmacy, Community/Retail PharmacyMN261996
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About NPI 1003921149

Supervalu Pharmacies Inc is an organization registered in the CMS NPPES NPI Registry with NPI number 1003921149. The primary specialty listed is Pharmacy, Community/Retail Pharmacy. The organization is located in Rochester, MN. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-08-20. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1003921149?

NPI 1003921149 belongs to Supervalu Pharmacies Inc, a Pharmacy, Community/Retail Pharmacy in Rochester, MN. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1003921149 active?

The current status of NPI 1003921149 in the NPPES registry is Active. The record was last updated on 2023-06-28.

What specialty is NPI 1003921149?

NPI 1003921149 is classified under the taxonomy Pharmacy, Community/Retail Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1003921149?

You can verify NPI 1003921149 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1003921149?

The primary practice address on file for NPI 1003921149 is 1021 15th Ave Se, Rochester, MN 55904. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1003921149 issued?

NPI 1003921149 was first issued (enumerated) on 2006-08-20. The NPPES record was last updated on 2023-06-28.

Practice Location Map

Supervalu Pharmacies Inc is located at 1021 15th Ave Se, Rochester, MN. Use the map below to find directions or verify the practice location.

📍 1021 15th Ave Se, Rochester, MN 55904  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Supervalu Pharmacies Inc. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1003921149. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
Pharmacy, Community/Retail Pharmacy261996MN
Data Verified from CMS NPPES Last synced: 2026-06-06 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162