Provider Demographics
NPI:1699813683
Name:DAKOTAMART INC
Entity Type:Organization
Organization Name:DAKOTAMART INC
Other - Org Name:LYNNS DAKOTAMART PHARMACY - HOT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-745-3110
Mailing Address - Street 1:3435 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2321
Mailing Address - Country:US
Mailing Address - Phone:605-745-3110
Mailing Address - Fax:605-745-7241
Practice Address - Street 1:501 S 6TH ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2318
Practice Address - Country:US
Practice Address - Phone:605-745-3110
Practice Address - Fax:605-745-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SD10018823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094329OtherPK
SD8510060Medicaid
2094329OtherPK