Provider Demographics
NPI:1225520299
Name:HENNEPIN HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM INC
Other - Org Name:HCMC G-1 PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-873-5340
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3225
Mailing Address - Fax:612-873-1969
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3225
Practice Address - Fax:612-873-1969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENNEPIN HEALTHCARE SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2629293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407897309OtherHENNEPIN HEALTHCARE SYSTEM INC