Organization
AVERA MCKENNAN
Active
Other names
Avera 69th Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DARREL MUTCHLER PHARMD (RETAIL PHARMACY MANAGER)
(605) 322-8331
Entity
Organization
Contact information
Practice address
4400 W 69TH ST STE 300, SIOUX FALLS, SD 57108-8170
(605) 322-5948
(605) 322-5949
Mailing address
4400 W 69TH ST STE 300, SIOUX FALLS, SD 57108-8170
(605) 322-5948
(605) 322-5949
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
100-1967
SD
333600000X
Pharmacy
1020
NE
333600000X
Pharmacy
Primary
4574
IA
3336C0003X
Community/Retail Pharmacy
054.019698
IL
3336S0011X
Specialty Pharmacy
264333
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962787440
—
IA
05
—
1962787440
—
MN
05
—
1962787440
—
SD
01
—
2132318
PK
—
Enumeration date
10/17/2011
Last updated
07/19/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us