1659533362 NPI number — REGIONS HOSPITAL INPATIENT PHARMACY

Table of content: (NPI 1659533362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659533362 NPI number — REGIONS HOSPITAL INPATIENT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONS HOSPITAL INPATIENT PHARMACY
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:
REGIONS HOSPITAL INPATIENT 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:
1659533362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55101-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-254-3592
Provider Business Mailing Address Fax Number:
651-254-9539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55101-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-254-3592
Provider Business Practice Location Address Fax Number:
651-254-9539
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
TY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER BUSINESS OPERATION
Authorized Official Telephone Number:
651-254-3528

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  200443 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30212100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2429000 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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