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General NPI Number Information
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NPI Number | 1952485328
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Entity Type | Individual
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Provider Name | JEFF DANIEL DEROUCHEY PHARM D
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3209 S LOUISE AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-0704
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Country | US
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Telephone | 605-362-1602
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Fax | 605-361-3476
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Provider Business Mailing Address
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Address Line | 5115 ROLLING GREEN AVE APT 308
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2218
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Country | US
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Telephone | 605-271-1181
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Fax | 605-361-3476
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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 | 5378
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License Number State | SD
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