Provider Demographics
NPI:1598791378
Name:SACRED HEART HOSPITAL & WESTERN MARYLAND HEALTH
Entity Type:Organization
Organization Name:SACRED HEART HOSPITAL & WESTERN MARYLAND HEALTH
Other - Org Name:SACRED HEART HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY OPS MGR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-723-5156
Mailing Address - Street 1:900 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1854
Mailing Address - Country:US
Mailing Address - Phone:301-723-5154
Mailing Address - Fax:302-723-5402
Practice Address - Street 1:900 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1854
Practice Address - Country:US
Practice Address - Phone:301-723-5154
Practice Address - Fax:302-723-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP007333336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109393OtherNCPDP PROVIDER IDENTIFICATION NUMBER