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General NPI Number Information
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NPI Number | 1699552752
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Entity Type | Organization
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Legal Business Name | SD DEPARTMENT OF CORRECTIONS PHARMACY
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 75 MICKELSON DRIVE
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City | YANKTON
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State | SD
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Zip | 57078
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Country | US
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Telephone | 605-668-5406
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Fax | 605-668-5988
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Provider Business Mailing Address
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Address Line | 75 MICKELSON DR, BOX 7
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City | YANKTON
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State | SD
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Zip | 57078
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Country | US
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Telephone | 605-668-5406
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Fax | 605-668-5988
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | TRACI CARLSON
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Credential | PHARM.D.
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Telephone | 605-668-5406
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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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