Healthcare Provider Details

I. General information

NPI: 1487697769
Provider Name (Legal Business Name): BROOKINGS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 22ND AVE
BROOKINGS SD
57006-2480
US

IV. Provider business mailing address

300 22ND AVE
BROOKINGS SD
57006-2480
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-6351
  • Fax:
Mailing address:
  • Phone: 605-692-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number1000515
License Number StateSD

VIII. Authorized Official

Name: STEVEN TIMMERMAN
Title or Position: DIR OF PHARMACY
Credential: RPH PHARMD
Phone: 605-696-7718