Shakopee Mdewakanton Sioux Community

Primary specialty

PharmacyTaxonomy code 333600000X

License

262982 Issued in MN

Legal business name

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

Doing business as

Shakopee Mdewakanton Sioux Comm Phcy
SMSC Pharmacy

Practice address

15045 Mystic Lake Dr NW
Prior Lake, MN 55372-9011

Phone

(952) 233-2900

Fax

(952) 233-8066

NPI assigned

Jan 23, 2007

Last updated

Jan 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William Weiers, RPHNPI 1598156531

Title

Pharmacy Director

Phone

(952) 233-2900

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• SHAKOPEE MDEWAKANTON SIOUX COMM PHCY Doing business as
• SMSC PHARMACY Doing business as

Tax ID family

Shakopee Mdewakanton Sioux2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Shakopee Mdewakanton Sioux Community

  dba Shakopee Mdewakanton Emergency Services

  • Ambulance
  • Prior Lake, MN
  • NPI 1700890134
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William J. Weiers

  • Pharmacist
  • Prior Lake, MN
  • NPI 1598156531
  NPD (past) Authorized official
• Matthew Steven Pivec, PHARM.D.

  • Pharmacist
  • Prior Lake, MN
  • NPI 1477944437
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1437203882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15045 MYSTIC LAKE DR NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729011",
            "telephone_number": "952-233-2900",
            "fax_number": "952-233-8066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15045 MYSTIC LAKE DR NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729011",
            "telephone_number": "952-233-2900",
            "fax_number": "952-233-8066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAKOPEE MDEWAKANTON SIOUX COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "WEIERS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "952-233-2900",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "262982",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049180",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHAKOPEE MDEWAKANTON SIOUX COMM PHCY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMSC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMSC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy A Scott, MD
• Raymond Lee Seaburg, D.D.S
• Brianna Marie Seawell, DPT
• Nneka Obiajulu Sederstrom, PHD, MPH, MA
• Shakopee Mdewakanton Sioux Community (Shakopee Dakota Clinic)
• Shakopee Mdewakanton Sioux Community (Shakopee Mdewakanton Emergency Services)
• Mark Shea
• Shepherds Path Senior Housing,Inc.
• Linda Handelsman Silverman, OT
• Julie Skovran, MT

• Pharmacy in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; 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.