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General NPI Number Information
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NPI Number | 1023173168
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Entity Type | Organization
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Legal Business Name | WALL DRUG STORE, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 510 MAIN STREET
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City | WALL
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State | SD
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Zip | 57790-0401
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Country | US
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Telephone | 605-279-1931
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Fax | 605-279-1030
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Provider Business Mailing Address
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Address Line | 510 MAIN STREET P O BOX 401
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City | WALL
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State | SD
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Zip | 57790-0401
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Country | US
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Telephone | 605-279-1931
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Fax | 605-279-1030
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Authorized Official
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Title or Position | PHARMACIST
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Name | CYNTHIA S DINGER
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Credential | PHARM D
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Telephone | 605-279-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 100-0054
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License Number State | SD
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