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General NPI Number Information
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NPI Number | 1861110876
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Entity Type | Organization
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Legal Business Name | AVERA MCKENNAN
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1301 S CLIFF AVE STE 225
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1068
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Country | US
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Telephone | 605-504-0491
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Fax | 605-504-0492
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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 | 605-322-8493
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Fax | 605-322-8453
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RONALD JOSEPH PLACE
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Credential |
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Telephone | 605-322-7903
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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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