Healthcare Provider Details

I. General information

NPI: 1124196274
Provider Name (Legal Business Name): ANN MARIE JORDRE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W SIOUX AVE
PIERRE SD
57501-2425
US

IV. Provider business mailing address

206 N TAYLOR AVE
PIERRE SD
57501-2914
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-7396
  • Fax:
Mailing address:
  • Phone: 605-224-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3747
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: