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General NPI Number Information
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NPI Number | 1629140967
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Entity Type | Organization
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Legal Business Name | PHARMACY SPECIALTIES & CLINIC, INC.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 2333 W 57TH ST STE 109
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5054
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Country | US
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Telephone | 605-334-1672
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Fax | 605-331-3243
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Provider Business Mailing Address
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Address Line | 2333 W 57TH ST STE 109
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5054
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Country | US
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Telephone | 605-334-1672
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Fax | 605-331-3243
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Authorized Official
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Title or Position | OWNER
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Name | CHERI ANN KRAEMER
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Credential | RPH
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Telephone | 605-334-1672
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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 | 1001793
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License Number State | SD
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