# AVERA QUEEN OF PEACE

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

## Provider details

- **NPI number:** 1710359252
- **Authorized official:** DOUGLAS EKEREN (PRESIDENT/CEO)
- **Authorized official phone:** (605) 668-8321

## Contact information

- **Practice address:** 1900 GRASSLAND DR, STE 101, MITCHELL, SD 57301
- **Practice address phone:** (605) 995-5670
- **Practice address fax:** (605) 996-6805
- **Mailing address:** 1900 GRASSLAND DR, STE 101, MITCHELL, SD 57301
- **Mailing address phone:** (605) 995-5670
- **Mailing address fax:** (605) 996-6805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 100-2030 | SD | Yes |

## Other

- **Enumeration date:** 10/23/2015
- **Last updated:** 09/14/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2154706 | PK | — |