Provider Demographics
NPI:1629140967
Name:PHARMACY SPECIALTIES & CLINIC, INC.
Entity Type:Organization
Organization Name:PHARMACY SPECIALTIES & CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-334-1672
Mailing Address - Street 1:2333 W 57TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5054
Mailing Address - Country:US
Mailing Address - Phone:605-334-1672
Mailing Address - Fax:605-331-3243
Practice Address - Street 1:2333 W 57TH ST STE 109
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5054
Practice Address - Country:US
Practice Address - Phone:605-334-1672
Practice Address - Fax:605-331-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10017933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500932Medicaid
SD1242740001Medicare NSC