Provider Demographics
NPI:1639315641
Name:AVISTA ADVENTIST HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:AVISTA ADVENTIST HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-673-1234
Mailing Address - Street 1:100 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9583
Mailing Address - Country:US
Mailing Address - Phone:303-673-1234
Mailing Address - Fax:303-673-1237
Practice Address - Street 1:100 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9583
Practice Address - Country:US
Practice Address - Phone:303-673-1234
Practice Address - Fax:303-673-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy