Provider Demographics
NPI:1598484883
Name:FLIEHS, MANDILYN
Entity Type:Individual
Prefix:
First Name:MANDILYN
Middle Name:
Last Name:FLIEHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 6TH AVE SE STE 23
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5190
Mailing Address - Country:US
Mailing Address - Phone:605-225-6344
Mailing Address - Fax:605-225-2695
Practice Address - Street 1:2201 6TH AVE SE STE 23
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5190
Practice Address - Country:US
Practice Address - Phone:605-225-6344
Practice Address - Fax:605-225-2695
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist