MEDICARE: DR. JEAN ROBERT KROEGER III PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6269	SD

General Provider Information

NPI Number	:	1215319132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN ROBERT KROEGER III PHARM.D.

Provider Business Mailing Address
First Line	:	1415 EGLIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9504
Country	:	US
Telephone Number	:	605-341-8621
Fax Number	:	605-341-8631

Provider Business Practice Location Address
First Line	:	1415 EGLIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9504
Country	:	US
Telephone Number	:	605-341-8621
Fax Number	:	605-341-8631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2015
Last Update Date	:	11/17/2020

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