Healthcare Provider Details

I. General information

NPI: 1346624772
Provider Name (Legal Business Name): STEPHANIE JUNGEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E MAIN ST
WESSINGTON SPRINGS SD
57382-0327
US

IV. Provider business mailing address

PO BOX 327
WESSINGTON SPRINGS SD
57382-0327
US

V. Phone/Fax

Practice location:
  • Phone: 605-539-1421
  • Fax: 605-539-1151
Mailing address:
  • Phone: 605-539-1421
  • Fax: 605-539-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6158
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: