# KIRK WILSON MARTIN DRUG & MERCANTILE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255416186
- **Authorized official:** MR. KIRK STEPHEN WILSON RPH (PHARMACIST)
- **Authorized official phone:** (605) 685-6200

## Contact information

- **Practice address:** 304 MAIN ST, MARTIN, SD 57551-0050
- **Practice address phone:** (605) 685-6200
- **Practice address fax:** (605) 685-6366
- **Mailing address:** 304 MAIN ST, BOX A, MARTIN, SD 57551-0050
- **Mailing address phone:** (605) 685-6200
- **Mailing address fax:** (605) 685-6366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 100-0514 | SD | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8500280 | — | SD |