Provider Demographics
NPI:1023131158
Name:PHS HOSPITAL ROSEBUD PHARMACY
Entity type:Organization
Organization Name:PHS HOSPITAL ROSEBUD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-3256
Mailing Address - Street 1:400 SOLDIER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0001
Mailing Address - Country:US
Mailing Address - Phone:605-747-2356
Mailing Address - Fax:605-747-5335
Practice Address - Street 1:400 SOLDIER CREEK RD
Practice Address - Street 2:400 SOLDIER CREEK RD
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0001
Practice Address - Country:US
Practice Address - Phone:605-747-2356
Practice Address - Fax:605-747-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549093Medicaid
SDPHS000Medicare UPIN
SD430084Medicare ID - Type Unspecified