Provider Demographics
NPI:1053456558
Name:SANFORD VERMILLION HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:SANFORD VERMILLION HOSPITAL PHARMACY
Other - Org Name:SANRORD VERMILLION HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8383
Mailing Address - Street 1:20 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3346
Mailing Address - Country:US
Mailing Address - Phone:605-677-3660
Mailing Address - Fax:605-677-3661
Practice Address - Street 1:20 S PLUM ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3346
Practice Address - Country:US
Practice Address - Phone:605-638-8455
Practice Address - Fax:605-624-8535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4302763OtherNCPCP NUMBER
SD8503670Medicaid