Provider Demographics
NPI:1801434279
Name:DAKOTA PHARMS, LLC
Entity type:Organization
Organization Name:DAKOTA PHARMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:KJERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-270-7609
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0878
Mailing Address - Country:US
Mailing Address - Phone:605-765-9458
Mailing Address - Fax:605-765-2225
Practice Address - Street 1:103 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1101
Practice Address - Country:US
Practice Address - Phone:605-765-9458
Practice Address - Fax:605-765-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1801434279Medicaid