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NPI Code Detail

MEDICARE: BETH J SUNDAHL PHARMD

MEDICARE: BETH J SUNDAHL PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18491CO
2183500000XPharmacistR5984SD

General Provider Information

NPI Number : 1043598667
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH J SUNDAHL PHARMD
Provider Business Mailing Address
First Line : 730 MOUNTAIN VIEW RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-2519
Country : US
Telephone Number : 605-342-8505
Fax Number : 605-342-8903
Provider Business Practice Location Address
First Line : 730 MOUNTAIN VIEW RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-2519
Country : US
Telephone Number : 605-342-8505
Fax Number : 605-342-8903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2011
Last Update Date : 09/27/2013

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