Provider Demographics
NPI:1639110539
Name:TARGET CORPORATION
Entity Type:Organization
Organization Name:TARGET CORPORATION
Other - Org Name:TARGET CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE ADMIN SPEC
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKEREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-696-2262
Mailing Address - Street 1:1039 NICOLLET AVE
Mailing Address - Street 2:TPS1154
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 ERNEST W BARRETT PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6860
Practice Address - Country:US
Practice Address - Phone:770-425-6895
Practice Address - Fax:770-425-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154486OtherOTHER ID NUMBER-COMMERCIAL NUMBER