Provider Demographics
NPI:1225030448
Name:TEL-DRUG INC
Entity Type:Organization
Organization Name:TEL-DRUG INC
Other - Org Name:CIGNA HOME DELIVERY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-809-8180
Mailing Address - Street 1:4901 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-0444
Mailing Address - Country:US
Mailing Address - Phone:605-373-4854
Mailing Address - Fax:800-973-7150
Practice Address - Street 1:4901 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0444
Practice Address - Country:US
Practice Address - Phone:605-373-4854
Practice Address - Fax:800-973-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1001332333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4062630001Medicare NSC