Provider Demographics
NPI:1861648099
Name:CARLE FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:CARLE FOUNDATION HOSPITAL
Other - Org Name:CARLE RX EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RX EXPRESS
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSZKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-383-4905
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-326-2913
Mailing Address - Fax:217-326-2996
Practice Address - Street 1:1818 E WINDSOR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-9566
Practice Address - Country:US
Practice Address - Phone:217-255-9790
Practice Address - Fax:217-255-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540164883336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1482253OtherNCPDP PROVIDER IDENTIFICATION NUMBER