Healthcare Provider Details

I. General information

NPI: 1780756858
Provider Name (Legal Business Name): SHELLY R ZITTLAU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N 4TH AVE
SIOUX FALLS SD
57104-0444
US

IV. Provider business mailing address

3705 S PILLSBERRY AVE
SIOUX FALLS SD
57103-7275
US

V. Phone/Fax

Practice location:
  • Phone: 605-373-0100
  • Fax:
Mailing address:
  • Phone: 605-373-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4818
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: