Provider Demographics
NPI:1265826770
Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
Other - Org Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC. #126
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-287-3600
Mailing Address - Street 1:29 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642
Mailing Address - Country:UM
Mailing Address - Phone:315-287-3600
Mailing Address - Fax:315-287-4291
Practice Address - Street 1:11131 W 79TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1482
Practice Address - Country:US
Practice Address - Phone:913-234-4664
Practice Address - Fax:913-234-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-131673336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7082550012Medicare NSC