Healthcare Provider Details

I. General information

NPI: 1376589176
Provider Name (Legal Business Name): HOFFMAN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MAIN ST
PLATTE SD
57369-0110
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 Code333600000X
TaxonomyPharmacy
License Number100-0474
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MAYDEW
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 605-337-3662