Provider Demographics
NPI:1700834116
Name:HINES VA CMOP
Entity Type:Organization
Organization Name:HINES VA CMOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF CONSULTANT PBM/CMOP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEHR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPA
Authorized Official - Phone:913-758-4750
Mailing Address - Street 1:5000 S 5TH AVE
Mailing Address - Street 2:BLDG. 37
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-786-7820
Mailing Address - Fax:708-786-7980
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:BLDG. 37
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-786-7821
Practice Address - Fax:708-786-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1478367OtherNCPDP#
ILBH4654617OtherDEA#