=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720462583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. RONDI SCOULAR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2015
-----------------------------------------------------
Last Update Date | 07/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 S MAIN ST
-----------------------------------------------------
City | MILBANK
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57252-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-432-5542
-----------------------------------------------------
Fax | 605-432-6258
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 S MAIN ST
-----------------------------------------------------
City | MILBANK
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57252-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-432-5542
-----------------------------------------------------
Fax | 605-432-6258
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5449
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 118545
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------