Provider Demographics
NPI:1518062629
Name:PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES
Entity Type:Organization
Organization Name:PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES
Other - Org Name:CENTERVILLE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-326-5161
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57014-0099
Mailing Address - Country:US
Mailing Address - Phone:605-563-2243
Mailing Address - Fax:605-563-3784
Practice Address - Street 1:513 BROADWAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014
Practice Address - Country:US
Practice Address - Phone:605-563-2243
Practice Address - Fax:605-563-3784
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-18343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100-1834OtherSTATE LICENSE
SD0921810002Medicare NSC