Provider Demographics
NPI:1811977390
Name:PRANG, JOCELYN F (RPH, DDSM)
Entity type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:F
Last Name:PRANG
Suffix:
Gender:F
Credentials:RPH, DDSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SAINT PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4645
Mailing Address - Country:US
Mailing Address - Phone:605-388-3622
Mailing Address - Fax:605-388-3711
Practice Address - Street 1:339 SAINT PATRICK ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4645
Practice Address - Country:US
Practice Address - Phone:605-388-3622
Practice Address - Fax:605-388-3711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500903Medicaid
SD1314400001Medicare ID - Type UnspecifiedMEDICARE