Provider Demographics
NPI:1659744100
Name:TWO FISHES INC
Entity Type:Organization
Organization Name:TWO FISHES INC
Other - Org Name:ROGER'S FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-8042
Mailing Address - Street 1:218 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4301
Mailing Address - Country:US
Mailing Address - Phone:605-665-8042
Mailing Address - Fax:605-665-1998
Practice Address - Street 1:218 W 4TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4301
Practice Address - Country:US
Practice Address - Phone:605-665-8042
Practice Address - Fax:605-665-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1002033332B00000X
NE608333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026543700Medicaid
2155146OtherPK
SD1659744100Medicaid
NE10026543700Medicaid