Healthcare Provider Details

I. General information

NPI: 1811003866
Provider Name (Legal Business Name): YANKTON MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 8TH ST
YANKTON SD
57078-3306
US

IV. Provider business mailing address

1104 W 8TH ST
YANKTON SD
57078-3306
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-2929
  • Fax: 605-665-8337
Mailing address:
  • Phone: 605-665-2929
  • Fax: 605-665-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1001876
License Number StateSD

VIII. Authorized Official

Name: CARMEN HUTCHISON
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 605-665-2929