AVERA MCKENNAN NPI 1669871000

NPI Information

NPI: 1669871000
Provider Name: AVERA MCKENNAN
Classification: Pharmacy - 3336L0003X
Specialization: Long Term Care Pharmacy
Entity Type: Organization
:
Address: 4101 W MEMORY CIRCLE
STE 120
SIOUX FALLS, SD
ZIP 57107
Phone: (855) 322-6922

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NPI Details

AVERA MCKENNAN is a long term care pharmacy pharmacy in Sioux Falls, SD. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. AVERA MCKENNAN NPI is 1669871000. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

4101 W MEMORY CIRCLE
STE 120
SIOUX FALLS, SD
ZIP 57107-504
Phone: (855) 322-6922
Fax: (855) 971-3544

The provider's authorized official is Ronald Joseph Place .
The authorized official title is President/ceo and has the following contact phone number (605) 322-7903.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Fee covid-19 vac 13 res (HCPCS:0124A)
Administration of influenza virus vaccine (HCPCS:G0008)
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
Adm sarscov2 30mcg/0.3ml bst (HCPCS:0004A)
Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)
Adm sarscov2 100mcg/0.5ml3rd (HCPCS:0013A)
Administration of pneumococcal vaccine (HCPCS:G0009)
Adm sarscov2 30mcg/0.3ml 3rd (HCPCS:0003A)
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use (HCPCS:90677)
Pneumococcal vaccine, 23-valent (HCPCS:90732)
Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 100 mcg/0.5ml dosage; first dose (HCPCS:0011A)
Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 100 mcg/0.5ml dosage; second dose (HCPCS:0012A)
Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; second dose (HCPCS:0002A)

The enumeration date for this NPI number is 8/21/2014 and was last updated on 4/29/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	333600000X	Pharmacy				No
2	3336C0003X	Pharmacy	Community/Retail Pharmacy			No
3	332B00000X	Durable Medical Equipment & Medical Supplies				No
4	3336C0004X	Pharmacy	Compounding Pharmacy			No
5	3336L0003X	Pharmacy	Long Term Care Pharmacy	100-1994	SOUTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2147429	OTHER		PK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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