MEDICARE: CONTINUED CARE LTC PHARMACY SOUTH DAKOTA LLC

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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1497418305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTINUED CARE LTC PHARMACY SOUTH DAKOTA LLC

Provider Business Mailing Address
First Line	:	PO BOX 329
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-0329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 W 53RD ST STE 200
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4254
Country	:	US
Telephone Number	:	888-277-2132
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	BRANDON A HAGEN
Credential	:
Telephone Number	:	888-557-4318

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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