Healthcare Provider Details

I. General information

NPI: 1154460996
Provider Name (Legal Business Name): CUSTER COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MOUNT RUSHMORE RD
CUSTER SD
57730-1531
US

IV. Provider business mailing address

PO BOX 878
PHILIP SD
57567-0878
US

V. Phone/Fax

Practice location:
  • Phone: 605-673-2225
  • Fax: 605-673-3577
Mailing address:
  • Phone: 605-270-7609
  • Fax: 605-859-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1002051
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DILLON KJERSTAD
Title or Position: PRESIDENT
Credential:
Phone: 605-270-7609