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General NPI Number Information
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NPI Number | 1235371535
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Entity Type | Organization
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Legal Business Name | MEDVANTX INC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 2503 E 54TH ST N STE M
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City | SIOUX FALLS
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State | SD
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Zip | 57104-5563
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Country | US
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Telephone | 605-978-3980
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Fax | 888-825-8473
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Provider Business Mailing Address
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Address Line | 2503 E 54TH ST N STE M
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City | SIOUX FALLS
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State | SD
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Zip | 57104-5563
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Country | US
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Telephone | 605-978-3980
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Fax | 888-825-8473
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | SEAN HARMS
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Credential | PHARM D
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Telephone | 605-978-3963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 1001950
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License Number State | SD
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