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General NPI Number Information
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NPI Number | 1699878710
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Entity Type | Organization
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Legal Business Name | PRESCRIPTION SHOP INC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 1200 S 7TH ST AVE STE 100
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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 | 605-336-1677
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Provider Business Mailing Address
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Address Line | 1200 S 7TH ST AVE STE 100
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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 | 605-336-1677
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Authorized Official
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Title or Position | OWNER,AO
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Name | CLIFF VAN HOVE
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Credential | RPH
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Telephone | 605-336-1816
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 100-0990
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License Number State | SD
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