Healthcare Provider Details

I. General information

NPI: 1255420873
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

911 W CEDAR ST STE 1
BERESFORD SD
57004-1616
US

IV. Provider business mailing address

2701 S MINNESOTA AVE SUITE 1
SIOUX FALLS SD
57105-4744
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-2633
  • Fax: 605-763-2303
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 Number1001865
License Number StateSD
# 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: 605-367-2800