Healthcare Provider Details

I. General information

NPI: 1356436844
Provider Name (Legal Business Name): SALEM DRUG INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH MAIN STREET
SALEM SD
57058
US

IV. Provider business mailing address

PO BOX 316
SALEM SD
57058
US

V. Phone/Fax

Practice location:
  • Phone: 605-425-2827
  • Fax: 605-425-2052
Mailing address:
  • Phone: 605-425-2827
  • Fax: 605-425-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number100-0946SD
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100-0946
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number100-0946
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-0946
License Number StateSD

VIII. Authorized Official

Name: MR. ERIC GROCOTT
Title or Position: OWNER/ PHARMACIST
Credential:
Phone: 605-425-2827