Provider Demographics
NPI:1700212305
Name:MIDDENDORF, ALEX (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MIDDENDORF
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N CAREER AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-1348
Mailing Address - Country:US
Mailing Address - Phone:605-367-7583
Mailing Address - Fax:
Practice Address - Street 1:4801 N CAREER AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-1329
Practice Address - Country:US
Practice Address - Phone:605-367-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA22077183500000X
SDR6248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist