Provider Demographics
NPI:1033437223
Name:WULLSTEIN PHARMACY INC.
Entity Type:Organization
Organization Name:WULLSTEIN PHARMACY INC.
Other - Org Name:BRANDON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WULLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:605-582-6000
Mailing Address - Street 1:116 E HOLLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-2658
Mailing Address - Country:US
Mailing Address - Phone:605-582-6000
Mailing Address - Fax:605-582-6200
Practice Address - Street 1:116 E HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1114
Practice Address - Country:US
Practice Address - Phone:605-582-6000
Practice Address - Fax:605-582-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8504600Medicaid
SD7554410001Medicare NSC
S104461Medicare UPIN