Provider Demographics
NPI:1740538230
Name:SOUTH DAKOTA HUMAN SERVICES CENTER PHARMACY
Entity type:Organization
Organization Name:SOUTH DAKOTA HUMAN SERVICES CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-3100
Mailing Address - Street 1:3515 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4917
Mailing Address - Country:US
Mailing Address - Phone:605-668-3182
Mailing Address - Fax:605-668-3156
Practice Address - Street 1:3515 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4917
Practice Address - Country:US
Practice Address - Phone:605-668-3182
Practice Address - Fax:605-668-3156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SD HUMAN SERVICES CENTER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10577283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1001017OtherSTATE PHARMACY LICENSE
SD0240070Medicaid
SD4303171OtherDEA NUMBER