| NPI | 1467711739 |
|---|---|
| Doing Business As | AVERA COMPOUNDING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RONALD JOSEPH PLACE President/CEO 605-322-7903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: SD 1001973) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PH29727) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IA 4140) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: MN 263952) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NE 714) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: AZ Y006782) | |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2023-10-04 |