=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114062072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDALLS REXALL PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 6TH ST
-----------------------------------------------------
City | BROOKINGS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-692-4461
-----------------------------------------------------
Fax | 605-692-0845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 6TH STREET
-----------------------------------------------------
City | BROOKINGS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-692-4461
-----------------------------------------------------
Fax | 605-692-0845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE FRIEDRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-692-4461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------