Organization
AVERA ST LUKES
Active
Other names
AVERA ST LUKES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RON JACOBSON (PRES)
(605) 627-5625
Entity
Organization
Contact information
Practice address
305 S STATE ST, ABERDEEN, SD 57401-4527
(605) 622-5545
(605) 622-5019
Mailing address
305 S STATE ST, ABERDEEN, SD 57401-4527
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
1000486
SD
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4300721
OTHER ID NUMBER
—
05
—
8502660
—
SD
Enumeration date
10/03/2006
Last updated
09/13/2007
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