Provider Demographics
NPI:1518288026
Name:EUREKA PHARMACY & GIFT SHOPPE INC
Entity Type:Organization
Organization Name:EUREKA PHARMACY & GIFT SHOPPE INC
Other - Org Name:VILAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-222-2988
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451-0347
Mailing Address - Country:US
Mailing Address - Phone:605-426-6551
Mailing Address - Fax:605-426-6321
Practice Address - Street 1:511 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451
Practice Address - Country:US
Practice Address - Phone:605-426-6551
Practice Address - Fax:605-426-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-19573336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8501282Medicaid
2125472OtherPK
SD8504640Medicaid