Provider Demographics
NPI:1144394909
Name:FAMILY DRUG INC
Entity Type:Organization
Organization Name:FAMILY DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-336-0445
Mailing Address - Street 1:423 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6815
Mailing Address - Country:US
Mailing Address - Phone:605-336-0445
Mailing Address - Fax:605-575-9187
Practice Address - Street 1:423 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6815
Practice Address - Country:US
Practice Address - Phone:605-336-0445
Practice Address - Fax:605-575-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-1006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500230Medicaid
SD9160670Medicare NSC
SD0839800001Medicare NSC