Healthcare Provider Details

I. General information

NPI: 1083291744
Provider Name (Legal Business Name): ALEXANDER CHMURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/16/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CTR RD.
KYLE SD
57752
US

IV. Provider business mailing address

4613 BOZEMAN CIR
RAPID CITY SD
57703-2108
US

V. Phone/Fax

Practice location:
  • Phone: 605-455-8245
  • Fax:
Mailing address:
  • Phone: 605-381-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5666
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: