Provider Demographics
NPI:1679971485
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:VANDERBILT INTEGRATED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-343-9595
Mailing Address - Street 1:726 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2151
Mailing Address - Country:US
Mailing Address - Phone:615-875-6000
Mailing Address - Fax:615-242-1151
Practice Address - Street 1:726 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2151
Practice Address - Country:US
Practice Address - Phone:615-875-6000
Practice Address - Fax:615-242-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA9-00018403336S0011X
AL1145073336S0011X
GAPHNR0009363336S0011X
FLPH301083336S0011X
KS22-1042103336S0011X
IL054.0195993336S0011X
ID43401MS3336S0011X
LAPHY.007524-NR3336S0011X
IA45443336S0011X
MO20170283883336S0011X
MN2651803336S0011X
KYTN21123336S0011X
IN64002111A3336S0011X
CTPCN.00034123336S0011X
MDP077243336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149461OtherPK
TNQ032348Medicaid