Provider Demographics
NPI:1619567625
Name:HENNEPIN HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM INC
Other - Org Name:HCMC SPECIALTY SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-873-5340
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-3225
Mailing Address - Fax:
Practice Address - Street 1:716 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407897309OtherNPI