Organization
STATELINE DRUG INC
Active
Other names
Smith's Drug
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SONSALLA PHARM.D (PHARMACIST/OWNER)
(605) 374-3897
Entity
Organization
Contact information
Practice address
301 MAIN AVE, BOX 360, LEMMON, SD 57638-1419
(605) 374-3897
(605) 374-5510
Mailing address
301 MAIN AVE, BOX 360, LEMMON, SD 57638-1419
(605) 374-3897
(605) 374-5510
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
100-0056
SD
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020209
—
ND
05
—
8501362
—
SD
Enumeration date
12/23/2006
Last updated
03/03/2021
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