MEDICARE: LEWIS DRUGS INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	1000988	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2093554	OTHER		PK

General Provider Information

NPI Number	:	1750470373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS DRUGS INC

Provider Business Mailing Address
First Line	:	2701 S MINNESOTA AVE STE 1
Second Line	:	SUITE 1
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4746
Country	:	US
Telephone Number	:	605-367-2850
Fax Number	:	605-367-2876

Provider Business Practice Location Address
First Line	:	2700 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3701
Country	:	US
Telephone Number	:	605-367-2210
Fax Number	:	605-367-2219

Authorized Official
Title or Position	:	EVP/CFO/AO
Name	:	SCOTT CROSS
Credential	:
Telephone Number	:	605-367-2800

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/19/2018

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