Organization Name: | DAKOTA COMPOUNDING PHARMACY |
NPI Number: | 1154464212 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAWN FOKKEN (OWNER) |
Mailing Address: | 628 Main Ave Ste C Brookings |
State: | SD US |
Postal Code: | 570061423 |
Phone Number: | 6056927992 |
Fax Number: | 6056922118 |
NPI Enumeration Date: | 02/15/2007 |
NPI Last Update Date: | 09/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | 1001922 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |