Provider Demographics
NPI:1659533362
Name:REGIONS HOSPITAL INPATIENT PHARMACY
Entity Type:Organization
Organization Name:REGIONS HOSPITAL INPATIENT PHARMACY
Other - Org Name:REGIONS HOSPITAL INPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER BUSINESS OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-254-3528
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-3592
Mailing Address - Fax:651-254-9539
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3592
Practice Address - Fax:651-254-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2004433336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30212100Medicaid
2429000OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN30212100Medicaid