Organization
AVERA MCKENNAN
Active
Other names
Avera Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
4101 W MEMORY CIR STE 115, SIOUX FALLS, SD 57107-6503
(605) 322-3940
(605) 322-3941
Mailing address
4101 W MEMORY CIR STE 115, SIOUX FALLS, SD 57107-6503
(605) 322-3940
(605) 322-3941
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH29727
FL
3336C0003X
Community/Retail Pharmacy
4140
IA
3336C0004X
Compounding Pharmacy
Primary
1001973
SD
3336C0004X
Compounding Pharmacy
263952
MN
3336C0004X
Compounding Pharmacy
714
NE
3336C0004X
Compounding Pharmacy
Y006782
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134952
PK
—
Enumeration date
05/08/2012
Last updated
07/24/2025
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