Healthcare Provider Details

I. General information

NPI: 1740400753
Provider Name (Legal Business Name): CIGNA TEL DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2008
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

1509 CALUMET RD
BROOKINGS SD
57006-3612
US

V. Phone/Fax

Practice location:
  • Phone: 800-835-3784
  • Fax:
Mailing address:
  • Phone: 605-692-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4780
License Number StateSD

VIII. Authorized Official

Name: MR. BRADLEY DUANE HENNINGS
Title or Position: PHARMACIST
Credential: RPH
Phone: 605-373-0100