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Organization Active NPI

Avera St Lukes

Doing business as Avera St Lukes Pharmacy

  • Institutional Pharmacy
  • Aberdeen, SD
National Provider Identifier
1386738102
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
1000486 Issued in SD
Legal business name
AVERA ST LUKES
Doing business as
Avera St Lukes Pharmacy
Practice address
305 S State St
Aberdeen, SD 57401-4527
Phone
(605) 622-5545
Fax
(605) 622-5019
NPI assigned
Oct 3, 2006
Last updated
Sep 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Ron Jacobson
Title
Pres
Phone
(605) 627-5625

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 1000486 SD Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

305 S State St
Aberdeen, SD 57401-4527

Mailing address

305 S State St
Aberdeen, SD 57401-4527

Other identifiers 2

IdentifierTypeStateIssuer
4300721OtherOTHER ID NUMBER
8502660MedicaidSD

Other names 1

  • AVERA ST LUKES PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amg Radiology Aberdeen25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1386738102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 S STATE ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S STATE ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014527",
            "telephone_number": "605-622-5545",
            "fax_number": "605-622-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "605-627-5625"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "SD",
            "license": "1000486",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4300721",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8502660",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA ST LUKES PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.