Healthcare Provider Details

I. General information

NPI: 1982190401
Provider Name (Legal Business Name): AUSTIN RAE BLOCK PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUSTIN RAE OLIVER

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 5TH ST
CANTON SD
57013-1759
US

IV. Provider business mailing address

303 E 5TH ST
CANTON SD
57013-1759
US

V. Phone/Fax

Practice location:
  • Phone: 605-987-2661
  • Fax: 605-987-2478
Mailing address:
  • Phone: 605-987-2661
  • Fax: 605-987-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6497
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: