Provider Demographics
NPI:1508177767
Name:PHARMERICA HOSPITAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PHARMERICA HOSPITAL PHARMACY SERVICES, INC.
Other - Org Name:SPECIALTY HOSPITAL OF MIDWEST CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF HOSPITAL DIVISION
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:LADEMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH, MS, MBA
Authorized Official - Phone:502-627-7552
Mailing Address - Street 1:1901 CAMPUS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2308
Mailing Address - Country:US
Mailing Address - Phone:502-627-7552
Mailing Address - Fax:502-261-2437
Practice Address - Street 1:8210 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-8518
Practice Address - Country:US
Practice Address - Phone:405-739-0800
Practice Address - Fax:405-739-6480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-5531282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital