Provider Demographics
NPI:1295980902
Name:MAYDEW, BRET J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:J
Last Name:MAYDEW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-0110
Mailing Address - Country:US
Mailing Address - Phone:605-337-3662
Mailing Address - Fax:605-337-2673
Practice Address - Street 1:408 MAIN
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369
Practice Address - Country:US
Practice Address - Phone:605-337-3662
Practice Address - Fax:605-337-2673
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5231OtherSTATE PHARMACY LICENSE