Provider Demographics
NPI:1982190401
Name:BLOCK, AUSTIN RAE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:AUSTIN
Middle Name:RAE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:RAE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1759
Mailing Address - Country:US
Mailing Address - Phone:605-987-2661
Mailing Address - Fax:605-987-2478
Practice Address - Street 1:303 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1759
Practice Address - Country:US
Practice Address - Phone:605-987-2661
Practice Address - Fax:605-987-2478
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist