Healthcare Provider Details

I. General information

NPI: 1144243270
Provider Name (Legal Business Name): FAMILY PHARMACY OF MOBRIDGE , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MAIN ST
MOBRIDGE SD
57601-2534
US

IV. Provider business mailing address

323 N MAIN ST
MOBRIDGE SD
57601-2534
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-3345
  • Fax: 605-845-5462
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1001796
License Number StateSD

VIII. Authorized Official

Name: MRS. SARAH ANDERSEN
Title or Position: OWNER
Credential:
Phone: 605-845-3345