Healthcare Provider Details

I. General information

NPI: 1801935499
Provider Name (Legal Business Name): DAVID ANTHONY MENTELE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROSEBUD IHS HOSPITAL SOLDIER CREEK ROAD
ROSEBUD SD
57570
US

IV. Provider business mailing address

4413 E 36TH ST DAVID MENTELE
SIOUX FALLS SD
57103
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-3235
  • Fax: 605-747-2216
Mailing address:
  • Phone: 605-747-3235
  • Fax: 605-747-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4723
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: