Provider Demographics
NPI:1306043146
Name:JEWISH HOSPITAL & ST MARY'S HEALTHCARE
Entity Type:Organization
Organization Name:JEWISH HOSPITAL & ST MARY'S HEALTHCARE
Other - Org Name:PHARMACY PLUS 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-363-3791
Mailing Address - Street 1:1850 BLUEGRASS AVE
Mailing Address - Street 2:ATTN PHARMACY PLUS
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1161
Mailing Address - Country:US
Mailing Address - Phone:502-363-3791
Mailing Address - Fax:
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:ATTN PHARMACY PLUS
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-363-3791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07194333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP07194OtherSTATE PHARMACY PERMIT