Provider Demographics
NPI:1316007354
Name:LEWIS FAMILY DRUG LLC
Entity Type:Organization
Organization Name:LEWIS FAMILY DRUG LLC
Other - Org Name:LEWIS FAMILY DRUG 69
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-367-2824
Mailing Address - Street 1:2701 S MINNESOTA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4746
Mailing Address - Country:US
Mailing Address - Phone:605-367-2800
Mailing Address - Fax:605-367-2876
Practice Address - Street 1:1227 VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1552
Practice Address - Country:US
Practice Address - Phone:712-476-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA13023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1622857OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA730549Medicaid
IA730549Medicaid