Healthcare Provider Details

I. General information

NPI: 1124005269
Provider Name (Legal Business Name): CAMPUS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N FOSTER ST
MITCHELL SD
57301-2966
US

IV. Provider business mailing address

525 N FOSTER ST
MITCHELL SD
57301-2966
US

V. Phone/Fax

Practice location:
  • Phone: 605-995-5670
  • Fax: 605-996-6805
Mailing address:
  • Phone: 605-995-5670
  • Fax: 605-996-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number100-1023
License Number StateSD

VIII. Authorized Official

Name: MRS. SHAWNA RAE HECK
Title or Position: CAMPUS PHARMACY MANAGER
Credential: R.PH.
Phone: 605-995-5670