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Organization
AVERA QUEEN OF PEACE
Active
Organization
AVERA QUEEN OF PEACE
Active
Other names
Avera Grassland Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EKEREN (PRESIDENT/CEO)
(605) 668-8321
Entity
Organization
Contact information
Practice address
1900 GRASSLAND DR, STE 101, MITCHELL, SD 57301
(605) 995-5670
(605) 996-6805
Mailing address
1900 GRASSLAND DR, STE 101, MITCHELL, SD 57301
(605) 995-5670
(605) 996-6805
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
100-2030
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154706
PK
—
Enumeration date
10/23/2015
Last updated
09/14/2020
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