Healthcare Provider Details

I. General information

NPI: 1235151259
Provider Name (Legal Business Name): LEWIS FAMILY DRUG L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CALUMET AVE SW
DE SMET SD
57231-2161
US

IV. Provider business mailing address

2701 S MINNESOTA AVE STE 1
SIOUX FALLS SD
57105-4744
US

V. Phone/Fax

Practice location:
  • Phone: 605-854-9033
  • Fax: 605-854-9114
Mailing address:
  • Phone: 605-367-2850
  • Fax: 605-367-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1001879
License Number StateSD

VIII. Authorized Official

Name: SCOTT CROSS
Title or Position: EVP
Credential:
Phone: 605-367-2800