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General NPI Number Information
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NPI Number | 1952436099
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HEMATOLOGY ONCOLOGY PHARMACY LTC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 1000 E 21ST ST SUITE 3100
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1035
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Country | US
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Telephone | 605-322-7595
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Fax | 605-322-7599
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Provider Business Mailing Address
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Address Line | 1000 E 21ST ST SUITE 3100
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1035
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Country | US
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Telephone | 605-322-7595
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Fax | 605-322-7599
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. YEE-LAI CHIU
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Credential | R. PH.
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Telephone | 605-322-7595
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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 | 100-1649
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License Number State | SD
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