MEDICARE: DAKOTAMART INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	1001882	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2094329	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699813683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTAMART INC

Provider Business Mailing Address
First Line	:	3435 W MAIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2321
Country	:	US
Telephone Number	:	605-745-3110
Fax Number	:	605-745-7241

Provider Business Practice Location Address
First Line	:	501 S 6TH ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2318
Country	:	US
Telephone Number	:	605-745-3110
Fax Number	:	605-745-7241

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	SARA E BUTTS
Credential	:
Telephone Number	:	605-745-3110

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/13/2023

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Directions to “DAKOTAMART INC ” Practice Location

Language	Start Address	Practice Location

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