Provider Demographics
NPI:1952436099
Name:PEDIATRIC HEMATOLOGY ONCOLOGY PHARMACY LTC
Entity Type:Organization
Organization Name:PEDIATRIC HEMATOLOGY ONCOLOGY PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YEE-LAI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:605-322-7595
Mailing Address - Street 1:1000 E 21ST ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1035
Mailing Address - Country:US
Mailing Address - Phone:605-322-7595
Mailing Address - Fax:605-322-7599
Practice Address - Street 1:1000 E 21ST ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1035
Practice Address - Country:US
Practice Address - Phone:605-322-7595
Practice Address - Fax:605-322-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-1649333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4304666OtherNCPDP NUMBER
SD4304666OtherNCPDP NUMBER