Healthcare Provider Details

I. General information

NPI: 1528184090
Provider Name (Legal Business Name): JUDITH JAYNE ZACHARIASEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S MARION RD
SIOUX FALLS SD
57106-3636
US

IV. Provider business mailing address

725 W CASCADE ST
SIOUX FALLS SD
57108-3129
US

V. Phone/Fax

Practice location:
  • Phone: 605-361-3347
  • Fax: 605-361-3417
Mailing address:
  • Phone: 605-330-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5273
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: