Provider Demographics
NPI:1669468906
Name:MILLER DRUG INC
Entity Type:Organization
Organization Name:MILLER DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:KJERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-859-2843
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0878
Mailing Address - Country:US
Mailing Address - Phone:605-472-1810
Mailing Address - Fax:605-472-1812
Practice Address - Street 1:1010 W 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1503
Practice Address - Country:US
Practice Address - Phone:605-472-1810
Practice Address - Fax:605-472-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
SD10000573336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1669468906Medicaid
MN096790400Medicaid
SD8501350Medicaid
MN096790400Medicaid