Provider Demographics
NPI:1174612121
Name:ABERDEEN MEDICAL CENTER PHARMACY, INC
Entity type:Organization
Organization Name:ABERDEEN MEDICAL CENTER PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-225-6344
Mailing Address - Street 1:2201 6TH AVE SE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5130
Mailing Address - Country:US
Mailing Address - Phone:605-225-6344
Mailing Address - Fax:605-225-2695
Practice Address - Street 1:2201 6TH AVE SE
Practice Address - Street 2:SUITE 23
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5130
Practice Address - Country:US
Practice Address - Phone:605-225-6344
Practice Address - Fax:605-225-2695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABERDEEN MEDICAL CENTER PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10005183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4302701OtherNABP#
SD8501740Medicaid
SD4302701OtherNABP#