Healthcare Provider Details

I. General information

NPI: 1851328751
Provider Name (Legal Business Name): REILLY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E. FIRST STREET
TEA SD
57064-0487
US

IV. Provider business mailing address

PO BOX 487
TEA SD
57064-0487
US

V. Phone/Fax

Practice location:
  • Phone: 605-368-5333
  • Fax: 605-368-5337
Mailing address:
  • Phone: 605-368-5333
  • Fax: 605-368-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-1869
License Number StateSD

VIII. Authorized Official

Name: VINCENT GERARD REILLY
Title or Position: OWNER
Credential: RPH
Phone: 605-368-5333