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Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Dermatology Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
6701 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2591
(605) 322-7695
(605) 322-7696
Mailing address
6701 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2591
(605) 322-7695
(605) 322-7696
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
265029
MN
3336C0002X
Clinic Pharmacy
100-1965
SD
3336C0003X
Community/Retail Pharmacy
Primary
4651
IA
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407141344
—
SD
01
—
2130603
PK
—
Enumeration date
06/17/2011
Last updated
10/04/2023
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