Healthcare Provider Details

I. General information

NPI: 1578416632
Provider Name (Legal Business Name): JUSTIN MUTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 N 3RD ST
SPEARFISH SD
57783-1125
US

IV. Provider business mailing address

2511 N 3RD ST
SPEARFISH SD
57783-1125
US

V. Phone/Fax

Practice location:
  • Phone: 605-645-2337
  • Fax:
Mailing address:
  • Phone: 605-645-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberR-5259
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: