Provider Demographics
NPI:1891217618
Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES INC
Other - Org Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC. #131
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PBM RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-287-3600
Mailing Address - Street 1:29 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1401
Mailing Address - Country:US
Mailing Address - Phone:315-287-3600
Mailing Address - Fax:315-287-4291
Practice Address - Street 1:1100 W CHESTNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-223-7710
Practice Address - Fax:724-223-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103469503Medicaid