NPIMap

Organization Active NPI

Sdsu Jackrabbit Pharmacy

  • Institutional Pharmacy
  • Brookings, SD
National Provider Identifier
1124177100
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
100-0492 Issued in SD
Legal business name
SDSU JACKRABBIT PHARMACY
Practice address
N Campus Dr
Sdsu Wellness Center Room 119
Brookings, SD 57007-0001
Phone
(605) 688-5410
Fax
(605) 688-5267
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michaela Willis
Title
VP for Student Affairs
Phone
(605) 688-4493

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Institutional Pharmacy 3336I0012X 100-0492 SD Primary

Addresses

Primary practice location

N Campus Dr
Sdsu Wellness Center Room 119
Brookings, SD 57007-0001

Mailing address

1440 North Campus Dr RM 102
Brookings, SD 57007
Phone (605) 688-5410

Other identifiers 1

IdentifierTypeStateIssuer
2093681OtherPK

Other names 1

  • SDSU Jackrabbit Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SD Dept of HLTH Dba CHI35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

1440 N Campus Dr
Rm 102
Brookings, SD 57007

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1124177100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 NORTH CAMPUS DR RM 102",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "57007",
            "telephone_number": "605-688-5410",
            "fax_number": "605-688-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N CAMPUS DR",
            "address_2": "SDSU WELLNESS CENTER ROOM 119",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570070001",
            "telephone_number": "605-688-5410",
            "fax_number": "605-688-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SDSU JACKRABBIT PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "MICHAELA",
        "authorized_official_title_or_position": "VP FOR STUDENT AFFAIRS",
        "authorized_official_telephone_number": "605-688-4493"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "SD",
            "license": "100-0492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2093681",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SDSU Jackrabbit Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SDSU Jackrabbit Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookings, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.