MEDICARE: LEWIS FAMILY DRUG, LLC

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	183500000X	Pharmacist	100-1879	SD
2	3336C0003X	Community/Retail Pharmacy	100-1879	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	102113	OTHER	SD	IMMUNIZATION - LEGACY

General Provider Information

NPI Number	:	1417966029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY DRUG, LLC

Provider Business Mailing Address
First Line	:	2701 S MINNESOTA AVE STE 1
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4746
Country	:	US
Telephone Number	:	605-367-2800
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
Country	:	US
Telephone Number	:	605-854-9033
Fax Number	:	605-854-9114

Authorized Official
Title or Position	:	DIRECTOR OF CORPORATE SERVICES
Name	:	DAVE NIELSEN
Credential	:
Telephone Number	:	605-367-2800

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/21/2022

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