Provider Demographics
NPI:1801142542
Name:TARGET CORPORATION AND SUBSIDIARIES
Entity type:Organization
Organization Name:TARGET CORPORATION AND SUBSIDIARIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STORTROEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-761-5056
Mailing Address - Street 1:1000 NICOLLET MALL # 0910
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3130 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2567
Practice Address - Country:US
Practice Address - Phone:612-761-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2377011OtherNCPDP PROVIDER IDENTIFICATION NUMBER