Provider Demographics
NPI:1518001023
Name:LORI L GIEDT
Entity Type:Organization
Organization Name:LORI L GIEDT
Other - Org Name:LORI'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-397-2363
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445
Mailing Address - Country:US
Mailing Address - Phone:605-397-2363
Mailing Address - Fax:605-397-4403
Practice Address - Street 1:1205 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-0347
Practice Address - Country:US
Practice Address - Phone:605-397-2363
Practice Address - Fax:605-397-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1000002333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8502070Medicaid
1033790001Medicare ID - Type Unspecified