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General NPI Number Information
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NPI Number | 1407141344
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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 | 06/17/2011
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 6701 S MINNESOTA AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2591
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Country | US
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Telephone | 605-322-7695
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Fax | 605-322-7696
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Provider Business Mailing Address
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Address Line | 6701 S MINNESOTA AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2591
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Country | US
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Telephone | 605-322-7695
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Fax | 605-322-7696
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 265029
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 100-1965
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4651
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License Number State | IA
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