Healthcare Provider Details

I. General information

NPI: 1295980902
Provider Name (Legal Business Name): BRET J. MAYDEW PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MAIN
PLATTE SD
57369
US

IV. Provider business mailing address

PO BOX 110
PLATTE SD
57369-0110
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-3662
  • Fax: 605-337-2673
Mailing address:
  • Phone: 605-337-3662
  • Fax: 605-337-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5231
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: