Provider Type Icon

AVERA MCKENNAN NPI 1962787440


NPI Information

NPI: 1962787440
Provider Name: AVERA MCKENNAN

Doing Business As: AVERA 69TH STREET PHARMACY

Classification: Pharmacy - 333600000X
Entity Type: Organization
Address:
4400 W 69TH ST STE 300
SIOUX FALLS, SD
ZIP 57108
Phone: (605) 322-5948
Get Directions

AVERA MCKENNAN is a pharmacy in Sioux Falls, SD. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. AVERA MCKENNAN NPI is 1962787440. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera 69th Street Pharmacy.

The provider's business location address is:

4400 W 69TH ST STE 300
SIOUX FALLS, SD
ZIP 57108-170
Phone: (605) 322-5948
Fax: (605) 322-5949

The provider's authorized official is Darrel Mutchler .
The authorized official title is Retail Pharmacy Manager and has the following contact phone number (605) 322-8331.

The enumeration date for this NPI number is 10/17/2011 and was last updated on 7/19/2018.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacy100-1967SOUTH DAKOTANo
2333600000XPharmacy1020NEBRASKANo
33336C0003XPharmacyCommunity/Retail Pharmacy054.019698ILLINOISNo
43336S0011XPharmacySpecialty Pharmacy264333MINNESOTANo
5333600000XPharmacy4574IOWAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11962787440MEDICAIDSOUTH DAKOTA
22132318OTHERPK
31962787440MEDICAIDMINNESOTA
41962787440MEDICAIDIOWA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.