Healthcare Provider Details

I. General information

NPI: 1457571457
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: 08/22/2020
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

224 TABOR CT
BRANDON SD
57005-1080
US

V. Phone/Fax

Practice location:
  • Phone: 605-373-0100
  • Fax:
Mailing address:
  • Phone: 605-582-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number5141
License Number StateSD

VIII. Authorized Official

Name: MRS. JESSICA ANN BEBENSEE
Title or Position: STAFF PHARMACIST
Credential: PHARM D
Phone: 605-582-8544