Provider Demographics
NPI:1659703312
Name:PHARMACY SPECIALTIES, INC
Entity Type:Organization
Organization Name:PHARMACY SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
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
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5053
Mailing Address - Country:US
Mailing Address - Phone:605-334-1672
Mailing Address - Fax:605-335-0855
Practice Address - Street 1:2333 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5053
Practice Address - Country:US
Practice Address - Phone:605-334-1672
Practice Address - Fax:605-335-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-18223336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100-1822OtherPHARMACY LICENSE
SD2011-2014OtherPCAB ACCREDITED