Healthcare Provider Details

I. General information

NPI: 1396834917
Provider Name (Legal Business Name): LEWIS FAMILY DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N BOONE ST
ROCK RAPIDS IA
51246-1537
US

IV. Provider business mailing address

2701 S MINNESOTA AVE STE 1
SIOUX FALLS SD
57105-4746
US

V. Phone/Fax

Practice location:
  • Phone: 712-472-4044
  • Fax: 712-472-9617
Mailing address:
  • Phone: 605-367-2800
  • Fax: 605-367-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number299
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT CROSS
Title or Position: EVP/CFO
Credential:
Phone: 605-367-2850