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General NPI Number Information
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NPI Number | 1316463219
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Entity Type | Organization
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Legal Business Name | AVERA MCKENNAN
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 1200 S. 7TH AVENUE SUITE 101
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City | SIOUX FALLS
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State | SD
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Zip | 57105
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Country | US
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Telephone | 605-336-1816
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Fax | 605-504-0201
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Provider Business Mailing Address
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Address Line | 1200 S. 7TH AVENUE SUITE 101
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City | SIOUX FALLS
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State | SD
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Zip | 57105
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Country | US
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Telephone | 605-336-1816
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Fax | 605-504-0201
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RONALD JOSEPH PLACE
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Credential | MD
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Telephone | 605-322-7903
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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 | 100-2048
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License Number State | SD
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