| NPI | 1962787440 |
|---|---|
| Doing Business As | AVERA 69TH STREET PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DARREL MUTCHLER Retail Pharmacy Manager 605-322-8331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: IA 4574) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: SD 100-1967) |
| 333600000X Pharmacy (Licence: NE 1020) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054.019698) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: MN 264333) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2018-07-19 |