Provider Demographics
NPI:1417966029
Name:LEWIS FAMILY DRUG, LLC
Entity Type:Organization
Organization Name:LEWIS FAMILY DRUG, LLC
Other - Org Name:LEWIS FAMILY DRUG #68
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:605-367-2800
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 1:111 CALUMET AVE SW
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231
Practice Address - Country:US
Practice Address - Phone:605-854-9033
Practice Address - Fax:605-854-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-1879183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8504430Medicaid
SD102113OtherIMMUNIZATION - LEGACY
1276580020Medicare NSC