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General NPI Number Information
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NPI Number | 1861126401
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Entity Type | Individual
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Provider Name | DUSAN MIRKOVIC PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 2791 DAKOTA AVE S
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City | HURON
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State | SD
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Zip | 57350-4411
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Country | US
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Telephone | 605-353-9513
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Fax | 605-353-9515
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Provider Business Mailing Address
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Address Line | 1401 ROLAND LN
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City | MITCHELL
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State | SD
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Zip | 57301-2155
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Country | US
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Telephone | 605-999-0471
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6972
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License Number State | SD
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