Healthcare Provider Details

I. General information

NPI: 1760866495
Provider Name (Legal Business Name): JOEL REPENNING PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S MINNESOTA AVE
SIOUX FALLS SD
57105-4744
US

IV. Provider business mailing address

503 KIA DR
HARTFORD SD
57033-2084
US

V. Phone/Fax

Practice location:
  • Phone: 605-367-2828
  • Fax:
Mailing address:
  • Phone: 605-760-3812
  • Fax: 605-760-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6039
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121671
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: