Organization
AVERA MCKENNAN
Active
Other names
Avera Long Term Care 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 CIRCLE, STE 120, SIOUX FALLS, SD 57107-6504
(855) 322-6922
(855) 971-3544
Mailing address
3820 N POTSDAM AVE STE 2, SIOUX FALLS, SD 57104-7057
(605) 322-1450
(605) 322-1451
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
100-1994
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147429
PK
—
Enumeration date
08/21/2014
Last updated
04/29/2025
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