Provider Demographics
NPI:1356477442
Name:DAKOTA COUNTRY PHARMACY INC
Entity Type:Organization
Organization Name:DAKOTA COUNTRY PHARMACY INC
Other - Org Name:DAKOTA COUNTRY PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:KJERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-270-7609
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0878
Mailing Address - Country:US
Mailing Address - Phone:605-859-2833
Mailing Address - Fax:605-859-3026
Practice Address - Street 1:130 S CENTER
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-0640
Practice Address - Country:US
Practice Address - Phone:605-859-2833
Practice Address - Fax:605-859-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
SD10019933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145900OtherPK
SD1356477442Medicaid