Healthcare Provider Details

I. General information

NPI: 1639794688
Provider Name (Legal Business Name): MIKINZE JONES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 CANDLEWOOD PL APT 107
RAPID CITY SD
57702-0190
US

IV. Provider business mailing address

4503 CANDLEWOOD PL APT 107
RAPID CITY SD
57702-0190
US

V. Phone/Fax

Practice location:
  • Phone: 605-380-0144
  • Fax:
Mailing address:
  • Phone: 605-380-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6803
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: