Provider Demographics
NPI:1942385372
Name:PEARSON DRUG AND JEWELRY CO.
Entity Type:Organization
Organization Name:PEARSON DRUG AND JEWELRY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:605-698-3622
Mailing Address - Street 1:420 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-1402
Mailing Address - Country:US
Mailing Address - Phone:605-698-3622
Mailing Address - Fax:605-698-3622
Practice Address - Street 1:420 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1402
Practice Address - Country:US
Practice Address - Phone:605-698-3622
Practice Address - Fax:605-698-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-0963333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8501312Medicaid
SD9161370Medicaid
SD9161370Medicaid