Provider Demographics
NPI:1841815917
Name:PROTEXTER, GRAHAM DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:DAVID
Last Name:PROTEXTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S MINNESOTA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4787
Mailing Address - Country:US
Mailing Address - Phone:605-367-2000
Mailing Address - Fax:
Practice Address - Street 1:2525 S ELLIS RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-7066
Practice Address - Country:US
Practice Address - Phone:605-367-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist