Provider Demographics
NPI:1013015056
Name:KESSLERS INC
Entity Type:Organization
Organization Name:KESSLERS INC
Other - Org Name:KESSLERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-6673
Mailing Address - Street 1:621 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4538
Mailing Address - Country:US
Mailing Address - Phone:605-225-6673
Mailing Address - Fax:605-225-1612
Practice Address - Street 1:621 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4538
Practice Address - Country:US
Practice Address - Phone:605-225-6673
Practice Address - Fax:605-225-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
SD100-04583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8502710Medicaid
2094161OtherPK
2094161OtherPK