Provider Demographics
NPI:1356436844
Name:SALEM DRUG INCORPORATED
Entity type:Organization
Organization Name:SALEM DRUG INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-425-2827
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058
Mailing Address - Country:US
Mailing Address - Phone:605-425-2827
Mailing Address - Fax:605-425-2052
Practice Address - Street 1:300 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058
Practice Address - Country:US
Practice Address - Phone:605-425-2827
Practice Address - Fax:605-425-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-0946SD183500000X
SD100-0946332B00000X, 3336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8502580Medicaid
SD8502580Medicaid