Anderson Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Canton, SD
NPI 1649372111 · NPPES record last updated Jan 25, 2013
Key facts
- NPI
- 1649372111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1000044 (SD)
- Legal business name
- ANDERSON PHARMACY INC
- Practice address
- 303 E 5TH St
Canton, SD 57013-1735 - Phone
- (605) 987-2661
- Fax
- (605) 987-2478
- NPI assigned
- Sep 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Arne Albert Anderson, RPH
- Title
- Pharmacist
- Phone
- (605) 987-2661
Corporate family (same tax ID) 1
Practitioners 3
-
Austin Rae Block, PHARM D
-
Bailey Schroeder, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930031842 | SD | DME Supplier - Pharmacy | 3476679077 | Practice locations: Canton, SD |
| O20170809000947 | SD | Part B Supplier - Mass Immunization (Roster Biller Only) | 3476679077 | Practice locations: Canton, SD |
National Provider Directory
- Tax ID family
- Anderson Pharmacy Inc
Locations
303 E 5th St
Canton, SD 57013
Phone (605) 987-2661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 1000044 | SD | Yes |
| Community/Retail Pharmacy | 3336C0003X | 3680 | IA |
Addresses
Primary practice location
303 E 5TH St
Canton, SD 57013-1735
Mailing address
303 E 5TH St
Canton, SD 57013-1735
Phone (605) 987-2661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8500590 | Medicaid | SD | |
| 0950204 | Medicaid | IA |
Other names
- Haisch Pharmacy
Other providers in Canton, SD
- Katie Aase
- Anderson Pharmacy Inc
- Arne Albert Anderson
- Becky Berentschot
- Austin Rae Block
- Bowling Green Inn of South Dakota, Inc.
- Bowling Green Inn of South Dakota, Inc.
All providers in Canton, SD · Community/Retail Pharmacy in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.