Provider Demographics
NPI:1255302311
Name:SPEIDEL, GALE MARIE (RPH, PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:MARIE
Last Name:SPEIDEL
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTN PHARMACY
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-719-8905
Mailing Address - Fax:605-719-4588
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:ATTN PHARMACY
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-719-8905
Practice Address - Fax:605-719-4588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist