# AVERA MCKENNAN

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

## Provider details

- **NPI number:** 1407141344
- **Authorized official:** RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
- **Authorized official phone:** (605) 322-7903

## Contact information

- **Practice address:** 6701 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2591
- **Practice address phone:** (605) 322-7695
- **Practice address fax:** (605) 322-7696
- **Mailing address:** 6701 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2591
- **Mailing address phone:** (605) 322-7695
- **Mailing address fax:** (605) 322-7696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 265029 | MN | — |
| 3336C0002X | Clinic Pharmacy | 100-1965 | SD | — |
| 3336C0003X | Community/Retail Pharmacy | 4651 | IA | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/17/2011
- **Last updated:** 10/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1407141344 | — | SD |
| 01 | — | 2130603 | PK | — |