| NPI | 1457923385 |
|---|---|
| Doing Business As | AVERA STATE STREET PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TODD ALLAN FORKEL President/CEO 605-622-5125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |