Active NPI
Avera St Lukes
Doing business as Avera State Street Pharmacy
- Pharmacy
- Aberdeen, SD
National Provider Identifier
1457923385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- AVERA ST LUKES
- Doing business as
- Avera State Street Pharmacy
- Practice address
- 105 S State St Ste 101
Aberdeen, SD 57401-4501 - Phone
- (605) 322-8331
- NPI assigned
- Jul 12, 2021
- Last updated
- Jul 12, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Todd Allan Forkel
- Title
- President/Ceo
- Phone
- (605) 622-5125
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | Primary |
Addresses
Primary practice location
105 S State St Ste 101
Aberdeen, SD 57401-4501
Mailing address
911 E 20TH St Ste 500
Sioux Falls, SD 57105-1047
Other names 1
- AVERA STATE STREET PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240502001268 | SD | Part B Supplier - Mass Immunization (Roster Biller Only) | 6406764927 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Aberdeen, SD |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
105 S State St
Ste 101
Aberdeen, SD 57401
Phone (605) 225-1945
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626048000000",
"number": "1457923385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 E 20TH ST STE 500",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571051047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 S STATE ST STE 101",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574014501",
"telephone_number": "605-322-8331"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA ST LUKES",
"organizational_subpart": "NO",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A",
"authorized_official_last_name": "FORKEL",
"authorized_official_first_name": "TODD",
"authorized_official_middle_name": "ALLAN",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "605-622-5125"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "AVERA STATE STREET PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Aberdeen, SD
- Avera St Lukes
- Avera St Lukes (Avera St Lukes Hospital Swingbed)
- Avera St Lukes (Avera Mother Joseph Manor)
- Avera St Lukes (Avera St Lukes Pharmacy)
- Avera St Lukes
- Avera St Lukes (Avera St Lukes Hospital ER CRNA)
- Avera St Lukes
- Avera St Lukes (Avera Medical Group Radiation Oncology Aberdeen)
- Avera St Lukes (Avera Plaza Pharmacy)
- Avera St Lukes (Avera Medical Group Aberdeen Surgical Associates)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.