Provider Demographics
NPI:1295018794
Name:MISSION HOSPITAL INC
Entity Type:Organization
Organization Name:MISSION HOSPITAL INC
Other - Org Name:MISSION PHARMACY - EMPLOYEE MAILORDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILCORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-213-0048
Mailing Address - Street 1:400 RIDGEFIELD CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2213
Mailing Address - Country:US
Mailing Address - Phone:828-257-7057
Mailing Address - Fax:828-257-7059
Practice Address - Street 1:400 RIDGEFIELD CT STE 106
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2213
Practice Address - Country:US
Practice Address - Phone:828-257-7057
Practice Address - Fax:828-257-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NC110723336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132034OtherPK