Susan Jane Nilsen, RPH
Individual provider Active NPI Pharmacist · Desmet, SD
NPI 1679618987 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679618987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- R4739 (SD)
- Practice address
- 201 Calumet Ave
Desmet, SD 57231 - Phone
- (605) 854-3861
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3599 | ND | MD | Social Worker |
| R4739 | SD | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | R4739 | SD | Yes |
| Pharmacist | 183500000X | 3599 | ND |
Addresses
Primary practice location
201 Calumet Ave
Desmet, SD 57231
Mailing address
103 14TH St NE
Watertown, SD 57201-2818
Phone (605) 886-2830
Other providers in Desmet, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.