Healthcare Provider Details

I. General information

NPI: 1104931146
Provider Name (Legal Business Name): R THOMAS BARTHOLOMEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 8TH AVE S
FAULKTON SD
57438-2115
US

IV. Provider business mailing address

PO BOX 70
FAULKTON SD
57438-0070
US

V. Phone/Fax

Practice location:
  • Phone: 605-598-4187
  • Fax: 605-598-6772
Mailing address:
  • Phone: 605-598-4187
  • Fax: 605-598-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1000009
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1000009
License Number StateSD

VIII. Authorized Official

Name: ROBERT THOMAS BARTHOLOMEW
Title or Position: OWNER PHARMACIST
Credential:
Phone: 605-598-4187