Provider Demographics
NPI:1740400753
Name:CIGNA TEL DRUG
Entity type:Organization
Organization Name:CIGNA TEL DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:HENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-373-0100
Mailing Address - Street 1:1509 CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3612
Mailing Address - Country:US
Mailing Address - Phone:605-692-7525
Mailing Address - Fax:
Practice Address - Street 1:4901 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0444
Practice Address - Country:US
Practice Address - Phone:800-835-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4780305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization