# AVERA MCKENNAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avera Long Term Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669871000
- **Authorized official:** RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
- **Authorized official phone:** (605) 322-7903

## Contact information

- **Practice address:** 4101 W MEMORY CIRCLE, STE 120, SIOUX FALLS, SD 57107-6504
- **Practice address phone:** (855) 322-6922
- **Practice address fax:** (855) 971-3544
- **Mailing address:** 3820 N POTSDAM AVE STE 2, SIOUX FALLS, SD 57104-7057
- **Mailing address phone:** (605) 322-1450
- **Mailing address fax:** (605) 322-1451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 100-1994 | SD | Yes |

## Other

- **Enumeration date:** 08/21/2014
- **Last updated:** 04/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2147429 | PK | — |