Provider Demographics
NPI:1164499539
Name:AMUNDSON ENTERPRISES INC
Entity type:Organization
Organization Name:AMUNDSON ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIRBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:605-886-4207
Mailing Address - Street 1:525 5TH ST SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4940
Mailing Address - Country:US
Mailing Address - Phone:605-886-4207
Mailing Address - Fax:605-886-0644
Practice Address - Street 1:525 5TH ST SE
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4940
Practice Address - Country:US
Practice Address - Phone:605-886-4207
Practice Address - Fax:605-886-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4302345OtherNABP NUMBER
SD8501160Medicaid
SD8501160Medicaid
SDS5568Medicare ID - Type UnspecifiedMEDICARE SERVICE CENTER