Healthcare Provider Details

I. General information

NPI: 1033437223
Provider Name (Legal Business Name): WULLSTEIN PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E HOLLY BLVD
BRANDON SD
57005-1114
US

IV. Provider business mailing address

116 E HOLLY BLVD
BRANDON SD
57005-2658
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-6000
  • Fax: 605-582-6200
Mailing address:
  • Phone: 605-582-6000
  • Fax: 605-582-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TOM WULLSTEIN
Title or Position: OWNER
Credential: PHARMD
Phone: 605-582-6000