Provider Demographics
NPI:1861601023
Name:MACK, CARI L (R,PH)
Entity type:Individual
Prefix:MRS
First Name:CARI
Middle Name:L
Last Name:MACK
Suffix:
Gender:F
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38535 174TH ST
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469-6600
Mailing Address - Country:US
Mailing Address - Phone:605-472-2166
Mailing Address - Fax:
Practice Address - Street 1:1010 W 1ST ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1506
Practice Address - Country:US
Practice Address - Phone:605-472-1810
Practice Address - Fax:605-472-1812
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist