Provider Demographics
NPI:1619185626
Name:GREGORY DRUG, INC
Entity Type:Organization
Organization Name:GREGORY DRUG, INC
Other - Org Name:GREGORY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEBELKORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-835-8198
Mailing Address - Street 1:604 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1349
Mailing Address - Country:US
Mailing Address - Phone:605-835-8198
Mailing Address - Fax:605-835-8827
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1349
Practice Address - Country:US
Practice Address - Phone:605-835-8198
Practice Address - Fax:605-835-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
SD10005053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500502Medicaid
SD8500033Medicaid