MEDICARE: STEPHANIE GANSCHOW 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
1	183500000X	Pharmacist	5227	SD

General Provider Information

NPI Number	:	1447337068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE GANSCHOW PHARMD

Provider Business Mailing Address
First Line	:	2409 S CAMDEN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106
Country	:	US
Telephone Number	:	605-362-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 E 52ND ST N
Second Line	:	CIGNA MEDICARE SERVICES
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-7106
Country	:	US
Telephone Number	:	605-373-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/05/2008

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