Healthcare Provider Details

I. General information

NPI: 1952436099
Provider Name (Legal Business Name): PEDIATRIC HEMATOLOGY ONCOLOGY PHARMACY LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 21ST ST SUITE 3100
SIOUX FALLS SD
57105-1035
US

IV. Provider business mailing address

1000 E 21ST ST SUITE 3100
SIOUX FALLS SD
57105-1035
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7595
  • Fax: 605-322-7599
Mailing address:
  • Phone: 605-322-7595
  • Fax: 605-322-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number100-1649
License Number StateSD

VIII. Authorized Official

Name: MR. YEE-LAI CHIU
Title or Position: PHARMACY MANAGER
Credential: R. PH.
Phone: 605-322-7595