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General NPI Number Information
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NPI Number | 1801534045
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Entity Type | Organization
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Legal Business Name | AVERA ST LUKES
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 2105 6TH AVE SE STE 24
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City | ABERDEEN
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State | SD
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Zip | 57401-6510
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Country | US
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Telephone | 605-322-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 911 E 20TH ST STE 500
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1047
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Country | US
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Telephone | 605-322-8331
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Fax |
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Authorized Official
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Title or Position | VP
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Name | TESS MOELLER
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Credential |
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Telephone | 605-622-2807
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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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