| NPI | 1740400753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY DUANE HENNINGS Pharmacist 605-373-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SD 4780) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2008-07-09 |