Healthcare Provider Details

I. General information

NPI: 1669301313
Provider Name (Legal Business Name): CC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 DISCOVERY CIR STE 2
RAPID CITY SD
57701-7969
US

IV. Provider business mailing address

2504 W MAIN ST
RAPID CITY SD
57702-2424
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-5122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GILBERT D MOYLE IV
Title or Position: MANAGING MEMBER
Credential:
Phone: 605-343-1966