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General NPI Number Information
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NPI Number | 1760974034
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Entity Type | Individual
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Provider Name | JAIME LYNN CANTU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 113 COMANCHE RD
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City | FORT MEADE
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State | SD
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Zip | 57741-1002
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Country | US
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Telephone | 605-347-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 602 S GARDEN ST
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City | HOT SPRINGS
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State | SD
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Zip | 57747-2202
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Country | US
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Telephone | 307-315-7571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | R-6639
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 4002
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4002
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License Number State | WY
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