Organization
DAKOTA COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN FOKKEN RPH (OWNER)
(605) 692-7992
Entity
Organization
Contact information
Practice address
628 MAIN AVE, STE C, BROOKINGS, SD 57006-1423
(605) 692-7992
(605) 692-2118
Mailing address
628 MAIN AVE, STE C, BROOKINGS, SD 57006-1423
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
1001922
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4353998
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/15/2007
Last updated
09/12/2007
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