MEDICARE: LEWIS FAMILY DRUG L L C

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	1001879	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2093758	OTHER		PK

General Provider Information

NPI Number	:	1235151259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY DRUG L L C

Provider Business Mailing Address
First Line	:	2701 S MINNESOTA AVE
Second Line	:	STE 1
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4744
Country	:	US
Telephone Number	:	605-367-2850
Fax Number	:	605-367-2876

Provider Business Practice Location Address
First Line	:	111 CALUMET AVE SW
Second Line	:
City	:	DE SMET
State	:	SD
Zip	:	57231-2161
Country	:	US
Telephone Number	:	605-854-9033
Fax Number	:	605-854-9114

Authorized Official
Title or Position	:	EVP
Name	:	SCOTT CROSS
Credential	:
Telephone Number	:	605-367-2800

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/21/2022

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Directions to “LEWIS FAMILY DRUG L L C ” Practice Location

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