1407864374 NPI number — LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407864374 NPI number — LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A. LPCH CHILDREN'S HOME PHARMACY B. STANFORD HOME PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407864374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 BOHANNON DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-497-8316
Provider Business Mailing Address Fax Number:
650-497-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 BOHANNON DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MENLO PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94025-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-497-8316
Provider Business Practice Location Address Fax Number:
650-497-8320
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NG
Authorized Official First Name:
MARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
650-497-8391

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0549381 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ41694Z . This is a "BLUE SHIELD HOME INFUSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: FP0549381 . This is a "BLUE SHIELD PHARM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003751 . This is a "BLUE CROSS PROVIDER#" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA 407800 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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