Provider Demographics
NPI:1013215086
Name:VANDERBILT UNIVERSITY
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY
Other - Org Name:VANDERBILT UNIVERSITY HOSPITAL OP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST DIIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-322-6480
Mailing Address - Street 1:THE VANDERBILT CLINIC RM 1815
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-322-6480
Mailing Address - Fax:615-322-4300
Practice Address - Street 1:1161 21ST AVE S RM 1815
Practice Address - Street 2:THE VANDERBILT CLINIC
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-6480
Practice Address - Fax:615-322-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10083336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3553303Medicaid
TNNCPDP PROVIDER IDOther4418972
TN3696789Medicare PIN
0773110001Medicare NSC