Provider Demographics
NPI:1215228911
Name:ST LUKE'S MERIDIAN INPT PHARMACY
Entity Type:Organization
Organization Name:ST LUKE'S MERIDIAN INPT PHARMACY
Other - Org Name:SLMMC INPT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONGTU
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-706-1523
Mailing Address - Street 1:520 S EAGLE RD
Mailing Address - Street 2:ATTN: BASEMENT
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6351
Mailing Address - Country:US
Mailing Address - Phone:208-706-1523
Mailing Address - Fax:208-706-1543
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:ATTN: BASEMENT
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-1523
Practice Address - Fax:208-706-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1632HP3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy