Provider Demographics
NPI:1083214217
Name:CHMURA, ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CHMURA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N LACROSSE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6965
Mailing Address - Country:US
Mailing Address - Phone:605-342-0881
Mailing Address - Fax:
Practice Address - Street 1:1200 N LACROSSE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6965
Practice Address - Country:US
Practice Address - Phone:605-342-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5590OtherPHARMACIST LICENSE