# DOUGLAS COUNTY MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prairie Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235161209
- **Authorized official:** MR. HEATH BROUWER (ADMINISTRATOR)
- **Authorized official phone:** (605) 724-2151

## Contact information

- **Practice address:** 1311 BRADDOCK AVE, ARMOUR, SD 57313-2136
- **Practice address phone:** (605) 724-2970
- **Practice address fax:** (605) 724-2310
- **Mailing address:** 1311 BRADDOCK AVE, ARMOUR, SD 57313-2136
- **Mailing address phone:** (605) 724-2970
- **Mailing address fax:** (605) 724-2310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 1001848 | SD | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 11/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8502460 | — | SD |
| 01 | — | 9167440 | MEDICAID DME | SD |