Healthcare Provider Details

I. General information

NPI: 1861126401
Provider Name (Legal Business Name): DUSAN MIRKOVIC PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 DAKOTA AVE S
HURON SD
57350-4411
US

IV. Provider business mailing address

1401 ROLAND LN
MITCHELL SD
57301-2155
US

V. Phone/Fax

Practice location:
  • Phone: 605-353-9513
  • Fax: 605-353-9515
Mailing address:
  • Phone: 605-999-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6972
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: