Provider Demographics
NPI:1992859383
Name:GIEDT, LORI LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LOUISE
Last Name:GIEDT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N MAIN ST
Mailing Address - Street 2:PO BOX 381
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445-0381
Mailing Address - Country:US
Mailing Address - Phone:605-397-2708
Mailing Address - Fax:
Practice Address - Street 1:1205 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-0347
Practice Address - Country:US
Practice Address - Phone:605-397-2363
Practice Address - Fax:605-397-4403
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8502070Medicaid
1033790001Medicare ID - Type Unspecified