Avera 69Th Street Pharmacy
LBN: Avera Mckennan
Avera 69Th Street Pharmacy is an health care organization with primary practice located at 4400 W 69Th St Ste 300 , Sioux Falls SD 57108-8170. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Pharmacy is the primary health care specialty.
Avera Mckennan can be contacted via phone (605) 322-5948, or through Mutchler, Darrel via phone (605) 322-8331.
Contact Information
Primary practice address
4400 W 69Th St Ste 300
Sioux Falls SD 57108-8170
Phone: (605) 322-5948
Fax: (605) 322-5949
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | 4574 | Iowa |
| Suppliers / Pharmacy | 333600000X | 100-1967 | South Dakota |
| Suppliers / Pharmacy | 333600000X | 1020 | Nebraska |
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 054.019698 | Illinois |
| Suppliers / Specialty Pharmacy | 3336S0011X | 264333 | Minnesota |
Profile Details
| NPI number | 1962787440 |
|---|---|
| LBN Legal business name | Avera Mckennan |
| DBA Doing business as | Avera 69Th Street Pharmacy |
| Authorized official | Mutchler, Darrel PHARMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 17th, 2011 |
| Last updated | Jul 19th, 2018 - about 8 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962787440 | NPPES |
| Other | 2132318 | PK | |
| MEDICAID | 1962787440 | PK | |
| MEDICAID | 1962787440 | PK | |
| MEDICAID | 1962787440 | PK |
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