Avera Dermatology Pharmacy
LBN: Avera Mckennan
Avera Dermatology Pharmacy is an health care organization with primary practice located at 6701 S Minnesota Ave , Sioux Falls SD 57108-2591. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Clinic Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Avera Mckennan can be contacted via phone (605) 322-7695, or through Place, Ronald Joseph via phone (605) 322-7903.
Contact Information
Primary practice address
6701 S Minnesota Ave
Sioux Falls SD 57108-2591
Phone: (605) 322-7695
Fax: (605) 322-7696
Website:
Authorized official contact:
Name: Place, Ronald Joseph Doctor of Medicine (MD)
Phone: (605) 322-7903
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | 265029 | Minnesota |
| Suppliers / Clinic Pharmacy | 3336C0002X | 100-1965 | South Dakota |
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 4651 | Iowa |
| Suppliers / Specialty Pharmacy | 3336S0011X |
Profile Details
| NPI number | 1407141344 |
|---|---|
| LBN Legal business name | Avera Mckennan |
| DBA Doing business as | Avera Dermatology Pharmacy |
| Authorized official | Place, Ronald Joseph Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jun 17th, 2011 |
| Last updated | Oct 4th, 2023 - about last year |
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 | 1407141344 | NPPES |
| South Dakota | MEDICAID | 1407141344 | |
| South Dakota | Other | 2130603 |
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