1528157146 NPI number — LEWIS DRUGS, INC.

Table of content: (NPI 1528157146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528157146 NPI number — LEWIS DRUGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS DRUGS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEWIS LONG TERM CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528157146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 S MINNESOTA AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-367-2800
Provider Business Mailing Address Fax Number:
605-367-2876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57103-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-367-2828
Provider Business Practice Location Address Fax Number:
605-367-2853
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIELSEN
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CORPORATE SERVICES
Authorized Official Telephone Number:
605-367-2824

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  1001856 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77859 . This is a "IMMUNIZATION - LEGACY" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4352655 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8502420 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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