Provider Demographics
NPI:1316013071
Name:DAKOTAMART INC
Entity Type:Organization
Organization Name:DAKOTAMART INC
Other - Org Name:LYNNS DAKOTAMART PHARMACY - BELLE FOURCHE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:EISCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-892-2666
Mailing Address - Street 1:3435 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2321
Mailing Address - Country:US
Mailing Address - Phone:605-892-2666
Mailing Address - Fax:605-892-2667
Practice Address - Street 1:600 NATIONAL ST
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2002
Practice Address - Country:US
Practice Address - Phone:605-892-2666
Practice Address - Fax:605-892-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SD10018813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094328OtherPK
SD8510050Medicaid
4321800002Medicare NSC