Provider Demographics
NPI:1730284845
Name:VAN R INC
Entity Type:Organization
Organization Name:VAN R INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN ROEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:605-224-6000
Mailing Address - Street 1:633 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3368
Mailing Address - Country:US
Mailing Address - Phone:605-224-6000
Mailing Address - Fax:605-224-6543
Practice Address - Street 1:633 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3368
Practice Address - Country:US
Practice Address - Phone:605-224-6000
Practice Address - Fax:605-224-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-05373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4303842OtherNCPDP
SD8504470Medicaid
SD8504470Medicaid
SD8504470Medicaid