Provider Demographics
NPI:1326648007
Name:MEYER, KRISTA ANN
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-2226
Mailing Address - Country:US
Mailing Address - Phone:605-695-2070
Mailing Address - Fax:
Practice Address - Street 1:3201 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0706
Practice Address - Country:US
Practice Address - Phone:605-362-2625
Practice Address - Fax:605-362-2626
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5216OtherSTATE LICENSE