Provider Demographics
NPI:1407864374
Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Entity Type:Organization
Organization Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Other - Org Name:A. LPCH CHILDREN'S HOME PHARMACY B. STANFORD HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:650-497-8391
Mailing Address - Street 1:4600 BOHANNON DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1034
Mailing Address - Country:US
Mailing Address - Phone:650-497-8316
Mailing Address - Fax:650-497-8320
Practice Address - Street 1:4600 BOHANNON DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1034
Practice Address - Country:US
Practice Address - Phone:650-497-8316
Practice Address - Fax:650-497-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0549381OtherNABP
ZZZ41694ZOtherBLUE SHIELD HOME INFUSION
FP0549381OtherBLUE SHIELD PHARM
003751OtherBLUE CROSS PROVIDER#
CAPHA 407800Medicaid
CAPHA 407800Medicaid