Healthcare Provider Details

I. General information

NPI: 1417966029
Provider Name (Legal Business Name): LEWIS FAMILY DRUG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CALUMET AVE SW
DE SMET SD
57231
US

IV. Provider business mailing address

2701 S MINNESOTA AVE STE 1
SIOUX FALLS SD
57105-4746
US

V. Phone/Fax

Practice location:
  • Phone: 605-854-9033
  • Fax: 605-854-9114
Mailing address:
  • Phone: 605-367-2800
  • Fax: 605-367-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number100-1879
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-1879
License Number StateSD

VIII. Authorized Official

Name: DAVE NIELSEN
Title or Position: DIRECTOR OF CORPORATE SERVICES
Credential:
Phone: 605-367-2800