Provider Demographics
NPI:1699552752
Name:SD DEPARTMENT OF CORRECTIONS PHARMACY
Entity type:Organization
Organization Name:SD DEPARTMENT OF CORRECTIONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:605-668-5406
Mailing Address - Street 1:75 MICKELSON DR, BOX 7
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-668-5406
Mailing Address - Fax:605-668-5988
Practice Address - Street 1:75 MICKELSON DRIVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-668-5406
Practice Address - Fax:605-668-5988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF SOUTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy