Provider Demographics
NPI:1295825297
Name:LEWIS DRUGS INC
Entity Type:Organization
Organization Name:LEWIS DRUGS INC
Other - Org Name:LEWIS DRUG #10
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO/AO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-367-2800
Mailing Address - Street 1:2701 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4744
Mailing Address - Country:US
Mailing Address - Phone:605-367-2850
Mailing Address - Fax:605-367-2876
Practice Address - Street 1:6109 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5981
Practice Address - Country:US
Practice Address - Phone:605-367-2510
Practice Address - Fax:605-367-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
SD1001919333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094342OtherPK
SD8503930-SDMedicaid
2094342OtherPK