Healthcare Provider Details

I. General information

NPI: 1700269636
Provider Name (Legal Business Name): JILL ANDERSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N HIGHWAY 77
DELL RAPIDS SD
57022-1530
US

IV. Provider business mailing address

48358 243RD ST
JASPER MN
56144-1057
US

V. Phone/Fax

Practice location:
  • Phone: 605-428-5440
  • Fax:
Mailing address:
  • Phone: 605-349-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4868
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: