Provider Demographics
NPI:1982601282
Name:KESSLER PHARMACY INC
Entity Type:Organization
Organization Name:KESSLER PHARMACY INC
Other - Org Name:JONES DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:605-225-6673
Mailing Address - Street 1:621 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4538
Mailing Address - Country:US
Mailing Address - Phone:605-225-6673
Mailing Address - Fax:605-225-1612
Practice Address - Street 1:816 6TH AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6315
Practice Address - Country:US
Practice Address - Phone:605-225-3010
Practice Address - Fax:605-225-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
SD10020173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148872OtherPK
SD8503610Medicaid