=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861601023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARI L. MACK R,PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 W 1ST ST
-----------------------------------------------------
City | REDFIELD
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57469-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-472-1810
-----------------------------------------------------
Fax | 605-472-1812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38535 174TH ST
-----------------------------------------------------
City | REDFIELD
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57469-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-472-2166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 4395
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------