Healthcare Provider Details

I. General information

NPI: 1043528227
Provider Name (Legal Business Name): BRYAN A OPITZ PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 5TH ST
HOT SPRINGS SD
57747-1480
US

IV. Provider business mailing address

402 N 25TH ST
HOT SPRINGS SD
57747-1109
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-2000
  • Fax:
Mailing address:
  • Phone: 307-258-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3351
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: