Healthcare Provider Details

I. General information

NPI: 1194069211
Provider Name (Legal Business Name): NICOLE MARIE HEPPER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE
SIOUX FALLS SD
57117-5045
US

IV. Provider business mailing address

1325 S CLIFF AVE
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5673
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: